Laparoscopic Cholecystectomy For Acute Cholecystitis Research Articles

Single-incision versus conventional multiport laparoscopic cholecystectomy in acute cholecystitis according to disease severity: single center retrospective study in Korea.

The safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis (AC) has not yet been confirmed. This single-center retrospective study included patients who underwent laparoscopic cholecystectomy (LC) for AC between April 2010 and December 2020. Propensity scores were used to match patients who underwent SILC with those who underwent conventional multiport LC (CMLC) in the entire cohort and in the two subgroups. A total of 1,876 patients underwent LC for AC, and 427 (22.8%) underwent SILC. In the propensity score-matched analysis of the entire cohort (404 patients in each group), the length of hospital stay (2.9 days vs. 3.5 days, p = 0.029) was shorter in the SILC group than in the CMLC group. No significant differences were observed in other surgical outcomes. In grade I AC (336 patients in each group), the SILC group showed poorer surgical outcomes than the CMLC group, regarding operation time (57.6 minutes vs. 52.4 minutes, p = 0.001) and estimated blood loss (22.9 mL vs. 13.1 mL, p = 0.006). In grade II/III AC (58 patients in each group), there were no significant differences in surgical outcomes between the two groups. Postoperative pain outcomes were also not significantly different in the two groups, regardless of severity. This study demonstrated that SILC had similar surgical and pain outcomes to CMLC in patients with AC; however, subgroup analysis showed that SILC was associated with poor surgical outcomes than CMLC in grade I AC. Therefore, SILC should be carefully performed in patients with AC by experienced hepatobiliary surgeons.

Combining preoperative C-reactive protein values with the Tokyo Guidelines 2018 grading criteria can enhance the prediction of surgical difficulty in early laparoscopic cholecystectomy for acute cholecystitis

BackgroundEarly laparoscopic cholecystectomy (ELC) is the standard treatment for acute cholecystitis (AC). However, predicting the difficulty of this procedure remains challenging. The present study aimed to develop an improved prediction model for surgical difficulty during ELC, surpassing the current Tokyo Guidelines 2018 (TG18) grading system. MethodsWe analyzed data from 201 consecutive patients who underwent ELC for AC between 2019 and 2021. Surgical difficulty was defined as the failure to achieve the critical view of safety (non-CVS). We developed a scoring system by conducting multivariate analysis on demographics, symptoms, laboratory data, and radiographic findings. The predictive accuracy of our scoring system was compared to that of the TG18 grading system (Grade I vs. Grade II/III). ResultsThrough multivariate logistic regression analysis, a novel scoring system was formulated. This system incorporated preoperative C-reactive protein (CRP) values (≥5: 1 pt, ≥10: 2 pts, ≥15: 3 pts) and TG18 grading score (duration >72 h: 1 pt, image criteria for Grade II AC: 1 pt). Our model, a cutoff score of ≥3, exhibited a significantly elevated area under the curve (AUC) of 0.721 compared to the TG18 grading system alone (AUC 0.609) (p = 0.001). ConclusionCombining preoperative CRP values with TG18 grading criteria can enhance the accuracy of predicting intraoperative difficulty in ELC for AC.

EGS P16 Laparoscopic cholecystectomy for acute cholecystitis versus diagnostic laparoscopy for suspected appendicitis: comparative time of admission to theatre and impact on reaching national guidance

Abstract Background Early laparoscopic cholecystectomy for acute cholecystitis reduces intra-operative complications. National AUGIS guidelines therefore propose laparoscopic cholecystectomy should be performed within 72 hours of diagnosis. Locally, laparoscopic cholecystectomies for acute cholecystitis are preferentially performed within Emergency General Surgery (EGS) theatres whilst diagnostic laparoscopies for suspected appendicitis within CEPOD. Access to EGS is anecdotally challenging when compared with CEPOD. Patients with acute cholecystitis may subsequently experience longer times from admission to theatre. This project aimed to compare patient timelines from admission/booking to theatre and evaluate the impact on reaching national AUGIS guidance, intra-operative findings and intra-operative drain insertions. Methods Retrospective analysis of patient records at a single tertiary centre was performed. All patients that underwent a laparoscopic cholecystectomy for imaging-confirmed acute cholecystitis (n=66) alongside patients who underwent diagnostic laparoscopy +/- appendicectomy for suspected acute appendicitis (February-June 2022) (n = 62) were included. Time from admission/booking to theatre was determined and independent t-tests performed for statistical comparison. Associations between prolonged waiting times (>72 hours) and severity of intra-operative findings (Parkland scores) (ordinal regression analysis) / intra-operative drain insertion (Chi squared analysis) were analysed. Results Patients undergoing laparoscopic cholecystectomies waited significantly longer from both admission to theatre and booking to theatre compared to patients undergoing diagnostic laparoscopy for suspected appendicitis (71.4 hours vs. 33.33 hours, mean difference 38.07 hours, p=<0.001; 26.93 hours vs. 15.57 hours, mean difference 11.36 hours, p=0.002;). 63.6% of laparoscopic cholecystectomies were performed within 72 hours of admission. Waiting over 72 hours for laparoscopic cholecystectomy was not associated with increased severity of intra-operative findings (higher Parkland scores) (estimate 0.40, p=0.519) or drain insertion (Chi-squared 0.886a, p=0.347). Mean age 57.2 years (range 19-93) and 36.3 (range 8-86) for cholecystectomy versus diagnostic laparoscopy, respectively. Conclusions Patients awaiting laparoscopic cholecystectomy experience significantly longer waiting times from admission and booking to theatre when compared to those awaiting diagnostic laparoscopy for suspected appendicitis. Local concordance with national AUGIS guidance is variable and a proportion of patients with acute cholecystitis wait beyond 72 hours for laparoscopic cholecystectomy. Waiting >72 hours within this tertiary centre is not, however, reflected by intra-operative findings or intra-operative drain insertion. Completion of laparoscopic cholecystectomies within CEPOD should be considered for cases of acute cholecystitis to minimise wait times.

OGBN P07 Is Emergency Cholecystectomy safe in the oldest old? A 10-year, single institution Retrospective study

Abstract Background The incidence and severity of presentation of cholelithiasis or its complications increases with increasing age. Higher risks of morbidity, longer hospital stay, and mortality are the potential challenges to this emergency procedure in this cohort. There is little UK based data citing outcomes of emergency surgery in this group of population. The aim of this study was to evaluate the safety of emergency cholecystectomy in patients aged 75 and above. Methods Data of consecutive patients aged 75+ undergoing an emergency laparoscopic cholecystectomy for acute cholecystitis at a London district general hospital between January 2013 and April 2023 was analysed. Outcomes of interest were time to procedure, length of hospital-stay, nature of complications and post-operative mortality. Results 123 patients were included. Median age was 80 years (Range 75-93). Median time from presentation to surgery was 4 days (Range 1-45), overall length of stay was 10 days (Range 1-62), and post-procedure stay was 6 days (Range 1-62). Conversion rate was 5% (n=6), overall complication rate was 11% (n=14) and, 4% (n=5) Clavien-Dindo grade 3-4 complications were observed. Bile leak was observed in 2 patients needing ERCP and re-admission rates were 8% (n=10). One patient died within 90 days postoperatively for reasons unrelated to the surgery. Conclusions This study shows that an emergency laparoscopic cholecystectomy has acceptable complication and readmission rates, and it should be considered even in the elderly population. Biologic age rather than demographic age influences the perioperative risks and decision for surgery should be multidisciplinary with risks and benefits carefully weighed with the patient case by case.

Delayed presentation of gallstone ileus due to spilled gallstones: A case report

Introduction: Gallstone ileus is a rare cause of intestinal obstruction and very few cases have been reported of spilled gallstones during a cholecystectomy resulting in a delayed presentation of gallstone ileus. Although complications from unretrieved gallstones are rare, there is a variety of post-operative complications described in the literature. Most complications occur within the first few months but can occur up to 10 years after the procedure. If complications arise, they may lead to significant morbidity and management may result in an invasive intervention, including a laparotomy. Case Report: An 83-year-old female underwent laparoscopic cholecystectomy for acute cholecystitis, during which several large gallstones spilled and an attempt at retrieval was made. Six years later, she presented to the emergency department with a small bowel obstruction due to gallstone ileus caused by an unretrieved spilled gallstone. She underwent laparotomy, and the gallstone was retrieved from the terminal ileum. Conclusion: Gallstone ileus can occur because of unretrieved spilled gallstones from a cholecystectomy. Although complications from unretrieved gallstones are rare, this case report highlights the importance of considering this as a differential diagnosis when patients present with symptoms consistent with intestinal obstruction after a cholecystectomy. It is important to attempt to retrieve spilled gallstones during cholecystectomy, but if this is not feasible, this should be documented, and patients should be informed of the potential risks of unretrieved stones although rare.

Symptom Duration and Surgeon Volume: Impact on Early Laparoscopic Cholecystectomy for Acute Cholecystitis.

The 'golden 72 hours' rule from the onset of symptoms still applies in laparoscopic cholecystectomy for acute cholecystitis. This rule has been discussed with increasing experience in laparoscopic surgery in recent years. This study aims to determine the optimal symptom duration based on the surgeon's volume when deciding on early laparoscopic cholecystectomy for acute cholecystitis. The patients were categorized into two groups: Group 1 (≤3 days) and Group 2 (>3 days) based on the symptom duration, andhigh-volume surgeons (performing >100 laparoscopic cholecystectomies in a year) and low-volume surgeons (performing <100 laparoscopic cholecystectomies in a year) based on the surgeon volume. All surgeons had received advanced training in laparoscopic surgery. There was no statisticaldifference in postoperative outcomes between groups, except for a few data (p>0.05). The operative time was longer in Group 2, the postoperative hospital stay was longer for low-volume surgeons than for high-volume surgeons after three days, and operative time was longer after three days than the first three days in low-volume surgeons (p<0.05). Early laparoscopic cholecystectomy may be recommended for acute cholecystitis with symptom duration of more than three days, regardless of the surgeon volume, as long as they are competent in laparoscopic surgeries.

Validation of a surgical difficulty grading system in laparoscopic cholecystectomy for acute cholecystitis.

The surgical difficulty of laparoscopic cholecystectomy (LC) for acute cholecystitis varies from case to case, and appropriate intraoperative evaluation would help prevent bile duct injury (BDI). We analyzed 178 patients who underwent LC for acute cholecystitis. Expert surgeons and trainees individually evaluated the surgical difficulty. The inter-rater agreement was analyzed using Conger's κ and Gwet's agreement coefficient (AC). Furthermore, we analyzed the predictive surgical difficulty item for performing subtotal cholecystectomy (STC). Regarding the inter-rater agreement between expert surgeons and trainees, 15 of the 17 surgical difficulty items had a Gwet's AC of 0.5 or higher, indicating "moderate" agreement or higher. Furthermore, the highest and total surgical difficulty scores were deemed "substantial" agreement. Scarring and dense fibrotic changes around the Calot's triangle area with easy bleeding with/without necrotic changes were predictive of whether STC should be performed. This surgical difficulty grading system is expected to be a tool that can be used by any surgeon with LC experience. STC should be performed to prevent BDI according to the changes around the Calot's triangle area.

The role of preoperative ultrasound in predicting conversion from laparoscopic cholecystectomy to open surgery in acute cholecystitis.

The aim of this study is to evaluate the role of pre-operative ultrasound findings for conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis and to evaluate the effects of pre-operative ultrasound findings on operation time and length of stay. The study included 80 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 1 and June 30, 2023. The relationship between gallbladder wall thickness and the presence of pericholecystic fluid on pre-operative ultrasonography and the duration of surgery, conversion to open surgery, and hospitalization was evaluated. The patient group undergoing open surgery exhibited a statistically significant increase in both the median gallbladder wall thickness (P<0.001) and the frequency of pericholecystic fluid on pre-operative ultrasound (P=0.012). Receiver operating characteristic (ROC) analysis was used to assess the discriminative power of gallbladder wall thickness for predicting the requirement to convert from laparoscopic surgery to open surgery. The area under the curve value was found to be 0.907, indicating a strong discriminative power. Based on the ROC curve, a gallbladder wall thickness of ≥5.75 millimeters showed a sensitivity of 85.7% and specificity of 84.9% in predicting the requirement for open surgery. Our study highlights the significance of two factors in predicting the conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis. The presence of pericholecystic fluid and a gallbladder wall thickness of 5.75 mm or greater are indicators that the laparoscopic procedure may be more challenging in such cases. These results can aid surgeons in making informed decisions and planning the surgical approach accordingly for better patient outcomes.

Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy

BackgroundImpact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established.MethodsThis single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 ≤ age < 80 years), and Group 3 (age ≥ 80 years). Risk factors for complications were assessed using logistic regression analysis.ResultsOf the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3.ConclusionAdvanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC.

Outcome of single-incision laparoscopic cholecystectomy compared to three-incision laparoscopic cholecystectomy for acute cholecystitis.

While single-incision laparoscopic cholecystectomy (SILC) has advantages in cosmesis and postoperative pain, its utilization has been limited. This study raises the possibility of expanding its indication to acute cholecystitis with the novel method of solo surgery under retrospective analysis. We compared the outcomes of SILC (n = 58) to those of three-incision laparoscopic cholecystectomy (TILC; n = 117) for acute cholecystitis, being performed from March 2014 to December 2015. Intraoperative results, including the operation time, did not differ significantly, except for drain catheter insertion (p = 0.004). Each group had 1 case of open conversion due to common bile duct injury. There was no significant difference in the length of hospital stay. Either group by itself was not a risk factor for complications, but in preoperative drainage for intraoperative perforation, 3 factors of intraoperative perforation, biliary complication, and history of upper abdominal operation for additional port, only American Society of Anesthesiology (ASA) scores for postoperative complication of Clavien-Dindo grades III and IV were significant risk factors. Our study findings showed comparative outcomes between both groups, providing evidence for the safety and feasibility of SILC for acute cholecystitis.

For safe and fast surgery: Utilization of the SAND balloon catheter for acute cholecystitis.

The utility of the SAND balloon catheter in laparoscopic cholecystectomy for acute cholecystitis (AC) remains unclear. A retrospective cohort study of patients who underwent emergency cholecystectomy at Shinshu University was performed to evaluate the efficacy of the SAND balloon catheter in cases of AC (SAND balloon utilization: Group S, n = 44; non-utilization: Group non-S, n = 47). The duration of surgery was significantly shorter in Group S than in Group non-S (p = .031). Despite comparable incidences of blood transfusions in the two groups, intraoperative blood loss was significantly less in Group S than in Group non-S (p = .013). The incidence of postoperative intraperitoneal infection tended to be higher in Group non-S (p = .076). Within Group non-S, bile spillage during operation was found in 16 (34.0%) patients. The multivariate analysis revealed that gangrenous AC was the strongest independent risk factor for bile spillage during operation (odds ratio [OR]: 19.1; 95% confidence interval [CI]: 2.84-78.4; p = .002), followed by surgeons with ≤10 years of experience (OR: 11.3; 95% CI: 1.81-70.6; p < .010). Implementation of the SAND balloon catheter in patients with AC is a safe and efficacious surgical option. This catheter is recommended in cases of gangrenous cholecystitis and for surgeons with limited experience.

Textbook outcome in the laparoscopic cholecystectomy of acute cholecystitis.

Textbook outcome (TO) is a novel composite measure of clinical outcomes that can be used to measure the quality of surgical outcomes. The aim of this cohort study was to propose TO criteria for laparoscopic cholecystectomy for acute cholecystitis and to identify reasons for TO failure and individual patient factors that predispose to failure. We retrospectively analyzed data for 189 patients with acute cholecystitis who underwent laparoscopic cholecystectomy. TO was defined as laparoscopic cholecystectomy without conversion to open cholecystectomy, intraoperative complications, postoperative complications (Clavien-Dindo classification ≥2), prolonged length of stay (≥10 days), readmission within 30 days, or mortality. TO was achieved in 154 of 189 patients who underwent laparoscopic cholecystectomy for acute cholecystitis. Medical costs were lower in the TO-achieved group than in the TO-failure group. Factors associated with TO failure on multivariate analysis were age > 70 years, hemoglobin <11.9 g/dL, and white blood cells >18 000 / μL (all P < .05). Applying TO to patients with acute cholecystitis allowed us to evaluate the overall quality of care related to hospitalization. TO may provide better assessment of the quality of care and help determine the treatment choice and reduce costs.

A domparative study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

Introduction- Inflammation of the gall bladder is known as acute cholecystitis. Sudden pain in the upper right of the abdomen along with bloating, vomiting, fever, tenderness are symptoms of acute cholecystitis. Laproscopic cholecystectomy is considered to be the gold standard for the treatment of acute cholecystitis.&#x0D; Objective- To compare operative and post-operative outcomes like operating time, injury to bile ducts, postoperative pain, total length of hospital stay, need for conversion to open cholecystectomy between immediate and late LC.&#x0D; Methodology- Sixty-eight patients aged between 18 to 60 years having acute cholecystitis admitted for laparoscopic cholecystectomy were included. Patients were categorized and analyzed based on length of time from presentation to surgery. We defined operation of cholecystectomy within 3 days of presentation as ‘early’ laparoscopic cholecystectomy and anywhere after 3 days as ‘delayed’ laparoscopic cholecystectomy. &#x0D; Results: The p value obtained for ROFA is 0.042. and that for Pain scale is 0.027. Since the p value is less than 0.05, the null hypothesis is rejected and we can conclude that there is a statistically significant difference between the means of two groups with respect to these factors. &#x0D; Conclusion- Both early and delayed laparoscopic cholecystectomy is possible and safe in the treatment of acute cholecystitis but return to full activity is early and pain scale is less in cases of early cholecystectomy.&#x0D;

Early laparoscopic cholecystectomy for acute cholecystitis: Does age matter?

Advances in laparoscopic surgery and perioperative care have improved the prognosis of operated patients, especially the oldest among them. This study aimed to assess the outcomes of early laparoscopic cholecystectomy for acute calculous cholecystitis in older adult patients. A retrospective analysis was carried out of 567 patients who underwent early laparoscopic cholecystectomy for acute calculous cholecystitis between January 2003 and July 2021. The outcomes of older adult patients (≥ 75 years) were compared with those of younger patients. The older adult group had significantly more patients with an American Society of Anesthesiologists score ≥3 (37.5% vs 8.3%; P < 0.001) and more severe acute calculous cholecystitis (grade II; 82.8% vs 67%; P = 0.01). There were no significant differences regarding operative time (90 vs 80 min; P = 0.064), conversion rate (20.3% vs 13.5%; P = 0.144), and both intra- and postoperative morbidity, principally bile duct injuries (1.6% vs 0%; P = 0.113) and bile leakage (0% vs 1.2%; P = 1). Early laparoscopic cholecystectomy could be proposed safely for older adult patients with mild and moderate acute cholecystitis. Geriatr Gerontol Int 2023; 23: 671-675.

Prolonged versus delayed laparoscopic cholecystectomy for acute cholecystitis: Time to change the concept – A multicenter randomized controlled trial

Prolonged versus delayed laparoscopic cholecystectomy for acute cholecystitis: Time to change the concept – A multicenter randomized controlled trial

Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis: A Secondary Center Experience.

Background Laparoscopic cholecystectomy (LC) has increasingly been accepted as the procedure of choice for the treatment of acute cholecystitis (AC). However, the timing of this procedure in the management of AC remains controversial. Hence this study was conducted to assess the feasibility of early laparoscopic cholecystectomy in acute cholecystitis. Materials and methods Patients who presented with symptoms of acute cholecystitis such as pain and tenderness in the right upper quadrant, systemic signs of inflammation, and positive ultrasound findings according to Tokyo guidelines were included for evaluation. Group 1 includes patients presented within 24 hours of the onset of symptoms whereas those presented between 25 and 72 hours of the onset of symptoms belonged to Group 2. All patients were taken up for early LC after assessment. Intraoperative and postoperative complications were analysed. Results Out of 120 patients, 37 belonged to Group 1 (30.83%) and 83 belonged to Group 2 (69.17%). There was a significant difference between the study groups in terms of certain demographic, laboratory findings and duration of surgery. None of the patients in Group 1 developed postoperative complications, whereas one patient in Group 2 had a bile leak on postoperative Day 2. Group 2 had a higher conversion rate to open procedure (p = 0.059). The mean duration of hospital stay for patients in Groups 1 and 2 were 3 and 3.3 days, respectively. Conclusion Laparoscopic cholecystectomy is safeand feasible with minimal conversion rates in patients presenting with early symptoms of AC. With the availability of good visualisation, optics, instruments and energy sources, good outcomes can be achieved.

How do magnetic resonance cholangiopancreatography findings predict conversion from laparoscopic cholecystectomy for acute cholecystitis to bailout procedures?

BackgroundAcute cholecystitis is one of the most prevalent surgical abdominal conditions. The Tokyo Guidelines describe the management of acute cholecystitis and recommend bailout procedures for “difficult” cholecystitis cases. This study aimed to identify risk factors for conversion from laparoscopic cholecystectomy to bailout procedures in patients with acute cholecystitis. MethodsThis retrospective cohort study was conducted at a single center between January 2017 and December 2021. Patients who underwent laparoscopic cholecystectomy for acute cholecystitis were enrolled and classified into bailout and non-bailout groups. The patients’ characteristics and perioperative data were compared between the 2 groups. ResultsIn total, 161 patients who underwent laparoscopic cholecystectomy for acute cholecystitis were reviewed. Fourteen were excluded because of a lack of preoperative magnetic resonance cholangiopancreatography; thus, 147 patients were enrolled (bailout group, 21; non-bailout group, 126). Age (74 vs 67 years old; P = .048), days from onset to surgery (3 vs 2 days; P = .02), or defect of cystic duct in magnetic resonance cholangiopancreatography (57% vs 29%; P = .02) were significantly associated with conversion to bailout procedures. In the logistic regression analysis, a defect of the cystic duct in magnetic resonance cholangiopancreatography was an independent predictor for bailout procedures (odds ratio, 2.793; P = .04). ConclusionIn this study, defect of the cystic duct in the magnetic resonance cholangiopancreatography can predict conversion to bailout procedures. To the best of our knowledge, this is the first report to describe magnetic resonance cholangiopancreatography finding of the cystic duct as a predictor of surgical difficulty in patients with acute cholecystitis.

The Optimal Timing of Laparoscopic Cholecystectomy in Acute Cholecystitis: A Single-Center Study.

Introduction Early laparoscopic cholecystectomy (ELC) is a treatment option for acute cholecystitis (AC). However, the timing of ELC is controversial. Delayed laparoscopic cholecystectomy (DLC) continues to be a common practice. This study aims to determine the optimal timing of ELC in AC. Materials and methods Patients who underwent surgery for AC between 2014 and 2020 were divided into three groups: immediate laparoscopic cholecystectomy (ILC), prolonged ELC (pELC), and DLC. The demographic, laboratory, radiological findings, and postoperative results of all patients were retrospectively reviewed. Results The study included 178 patients, with 63 in the ILC group, 27 in the pELC group, and 88 in the DLC group. Postoperative outcomes, excluding hospital stay, were similar between the groups. The total hospital stay was significantly longer in the pELC and DLC groups (p<0.05). In addition, postoperative hospital stay was longer in the pELC group (p<0.05), and 17.7% of the patients who waited for delayed surgery experienced recurrent attacks during the interval period. Conclusion ILC is recommended in AC to minimize hospital stays.

Racial disparities in time to laparoscopic cholecystectomy for acute cholecystitis

BackgroundDisparities in healthcare exist, yet few data are available on racial differences in time from admission to surgery. This study aimed to compare time from admission to laparoscopic cholecystectomy for acute cholecystitis between non-Hispanic Black and non-Hispanic White patients. MethodsPatients who underwent laparoscopic cholecystectomy for acute cholecystitis from 2010 to 2020 were identified using NSQIP. Time to surgery and additional preoperative, operative, and postoperative variables were analyzed. ResultsIn the univariate analysis, 19.4% of Black patients experienced a time to surgery >1 day compared with 13.4% of White patients (p < 0.0001). In the multivariable analysis, controlling for potential confounding factors, Black patients were found to be more likely than White patients to experience a time to surgery >1 day (OR 1.23, 95% CI 1.17–1.30, p < 0.0001). ConclusionsFurther investigation is indicated to better define the nature and significance of gender, race, and other biases in surgical care. Surgeons should be aware that biases may adversely impact patient care and should strive to identify and proactively address them to promote health equity in surgery.

Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases.

Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (< 72h) and expanded the surgical indication to severe AC. This study aimed to evaluate the clinical outcomes of ELC for AC following the TG18 in a single high-volume center. From 2019 to 2021, we managed all AC patients with a TG18 flowchart and prospectively enrolled those who underwent ELC within 7days of symptom onset. The primary outcome was overall morbidity, with a comparison between mild (Grade I) and moderate/severe (Grade II/III) AC. During the study period, 201 patients underwent ELC was for Grade I (56.2%), II (40.3%), and III (3.5%) ACs. Mean age was 69 ± 15.2years and time to surgery from symptom onset was 0 (12.9%), 1-3 (66.7%), and 4-7days (20.4%). Mean operative time and blood loss were 118.9 ± 42.7min and 57.8 ± 99.4mL, respectively. The critical view of safety (CVS) was achieved in 76.1% of patients, and bailout procedures were performed in 21.4%. There were no open conversions or bile duct injuries. Major morbidities (Clavien-Dindo classification ≥ IIIa) were observed in 5.5% of cases and mortality in 0.5%. Comparing Grades II/III to Grade I, operative time was longer (112.3 vs. 127.3min, p = 0.014), blood loss was higher (40.3 vs. 80.1mL, p = 0.005), the CVS rate was lower (83.2 vs. 67.0%, p = 0.012), and the major morbidity rate was higher (1.8 vs. 10.2%, p = 0.012). In the subgroup analysis of Grade II/III, there were no significant differences in major morbidities (p = 0.288) between the two groups (0-3 vs. 4-7days). ELC for AC following TG18 is feasible with low morbidity rates. However, ELC for Grade II/III ACs remains challenging, and surgeons must carefully assess intraoperative difficulties and surgical risks before proceeding.