Surgical Treatment Of Acute Cholecystitis Research Articles

LAPAROSCOPIC CHOLECYSTECTOMY VS OPEN CHOLECYSTECTOMY IN THE TREATMENT OF ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY CONDUCTED AT ONE OF THE TERTIARY CARE CENTRES IN NOTHRERN INDIA.

Background: Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no denitive data on its use in AC has been published. To Objective: compare the results of laparoscopic cholecystectomy (LC) with those of open cholecystectomy (OC) in the treatment of acute cholecystitis. Materials and Methodology: A prospective study was conducted among 30 patients who have taken surgical treatment for acute cholecystitis by taking their prior consents at Surgery Department, Career Institute OF Medical Sciences, Lucknow for 1 year. The patients underwent surgery within 72 hours of the onset of symptoms. The pa tients were selected for LC or OC depending on the surgeon's experience in laparoscopic surgery. Operating time, rate of con- version from LC to OC, complications, and length of hos pital stay were the main outcomes which were noted in both procedures. Conversion from LC to OC was necessary in 15% of the patients. The Results: mean operating time was 77 minutes for the OC group and 88 minutes for the LC group (P<.001). Complications occurred in 14% of the patients in the LC group and in 23% of the patients in the OC group, with no signicant differences between the 2 groups (P=.06). The number of moderate or severe com- plications was similar in both groups, whereas mild com- plications were more common in the OC group (P<.02). The length of the hospital stay averaged 8.1 days for the OC group and 3.3 days for the LC group (P<.001). Laparoscopic cholecystectomy is a s Conclusions: afe, valid alternative to OC in patients with acute cholecystitis. The technique has a low rate of complications, implies a shorter hospital stay, and offers the patient a more comfortable postoperative period than OC

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Surgical Treatment of Acute Cholecystitis in Patients over 80 Years: 10-Year Experience

The prevalence of gallstones ranges from 20% to 30% in patients ≥ 60 years of age whereas it is higher in individuals ≥ 90 years of age. Elderly patients with gallstones tend to develop more complications such as gallbladder hydrops, empyema or perforation. Although perioperative morbidity and mortality is slightly high in elderly patients with acute cholecystitis, cholecystectomy is successfully performed for acute cholecystitis with regard to improvement in patients care. In this study, we aimed to evaluate the results of patients over 80 years of age who had cholecystectomy. The data of the 196 patients over 80 years of age who underwent cholecystectomy for acute cholecystitits between Jan 2011and August 2020 were retrospectively reviewed. The age of the patients in this study ranged from 80 to 97 years. The number of female patients was 111 and male patients was 85. 109 patients underwent laparoscopic cholecystectomy and 77 patients underwent open cholecystectomy. 10 patients converted from laparoscopic to open surgery. One patient who underwent open cholecystectomy died. We observed more wound infection in open cholecystectomy group. Laparoscopic cholecystectomy patients were discharged earlier. Age is not a contraindication for cholecystectomy in patients with acute cholecystitits. Cholecystectomy is a safe procedure in elderly patients with accepted morbidity.

PECULIARITIES OF CLINICAL COURSE OF ACUTE CALCULOUS CHOLECYSTITIS

Introduction. Rational approaches to the diagnosis and tactics of surgical treatment of acute cholecystitis have resulted in the cut down in postoperative mortality. Despite the frequent occurrence of acute cholecystitis in everyday practice, interest in the problem of its treatment does not fade. With such an extensive and comprehensive investigation of this issue, the availability of international and national recommendations, nevertheless, there are some unresolved issues, including, in particular, the problem of the treatment of acute calculous cholecystitis, the peculiarities of its diagnosis and clinical course. The aim of the study is to elucidate the peculiarities of the clinical course of acute calculous cholecystitis. Methods. We analyzed the findings of diagnostic procedures of 209 patients who received inpatient treatment for uncomplicated acute calculous cholecystitis at the surgical department of the Malovyskivska Central District Hospital, Kirovograd region, from 2016 to 2021. The age of all patients ranged from 18 to 89 years. Results. Ultrasound examination of the abdominal organs plays an important role in the diagnosis of acute and chronic cholecystitis in everyday practice. The patients indicated a history of attacks of hepatic colic, mechanical jaundice. Having analyzed the anamnesis data, we determined the duration of cholelithiasis and the duration of acute calculous cholecystitis in the participants. The most typical symptom of acute cholecystitis was constant or paroxysmal pain with localization in the right hypochondrium. Conclusions. The course of acute calculous cholecystitis in the patients is characterized by a polymorphic clinical picture, its severity is less pronounced due to the depth of pathomorphological changes in the gallbladder wall. Complications of acute calculous cholecystitis produce a significant impact on the course of the disease, moreover, the severity of the systemic inflammatory reaction and concomitant pathology of the patients ' condition is also predetermined by the presence of concomitant pathology.

Regional variations in Sweden over time regarding the surgical treatment of acute cholecystitis: a population-based register study

Objective To provide optimal health care for patients with acute cholecystitis in need of acute cholecystectomy, resource allocation has to be optimized. The aim of this study was to assess possible regional inequity regarding the treatment of acute cholecystitis and explore regional differences in the management of acute cholecystitis. Methods Data were retrieved from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde CholangioPancreatography. Between January 2010 and December 2019, 22,985 patients who underwent cholecystectomy for acute cholecystitis and without prior history of acute cholecystitis were included in the study. The ratio of cholecystectomies with acute cholecystitis performed within two days of admission to hospital compared to population density was studied. Furthermore, the proportion of acute performed cholecystectomies within two days of admission in regions, with or without tertiary care centers, was also examined. Results No correlation between population density and proportion of acute performed cholecystectomies was found. Regions without tertiary care centers had a higher proportion of acute cholecystectomies performed within two days (5–10%). The difference in the ratio of acute cholecystectomies within two days of admission was significant for all years investigated except 2010. Conclusions The presence of a tertiary referral center within the region had a greater influence than the population density on the chance of undergoing acute cholecystectomy for patients with acute cholecystitis. There are several potential explanations for this, one being an interference of the needs of patients requiring tertiary referral center care with the needs of patients in need of acute care surgery.

Racial Disparities in the Surgical Treatment of Acute Cholecystitis

Racial Disparities in the Surgical Treatment of Acute Cholecystitis

The optimal timing of surgical treatment of acute cholecystitis according to evidence-based studies

Aim . To analyze of the optimal time of surgical treatment of acute cholecystitis based on the results of evidence-based studies of domestic and foreign clinical guidelines. Materials and methods . A review has been conducted based on an analysis of the clinical recommendations of the Russian Federation and other countries and meta-analyzes of clinical trial, published since 2015. Results . The surgical method is the main treatment approach of acute cholecystitis both in our country and abroad. Possible differences in assessing the results of surgical interventions are due to different ways of determining the time to perform the surgery (report from the onset of the disease, from the diagnosis, and also taking into account the time of hospitalization). In the majority of the world evidence-based studies early cholecystectomy have been defined as a surgery within 3-7 days after onset. The expediency of performing early operations with a persistent attack of acute cholecystitis is due to the inability to control the course of gallbladder's inflammation, the shorter duration of hospitalization and cost-effectiveness advantages. Conclusion . In clinical practice, taking into account the heterogeneity of the patient population with acute cholecystitis and various conditions for the provision of surgical care, early operations within the first three days from the onset of symptoms remains preferred.

Surgical treatment of acute cholecystitis in obese patients.

&lt;b&gt;Introduction:&lt;/b&gt; In today's technological climate, science and medicine have entered a new era. At the level of technological progress, we have identified millennia of "new" problems and diseases. If earlier diseases had a certain individuality then, in the third millennium, we face compliance and synergistic influence of diseases. Obesity is a problem of the third millennium. It is known that obesity is the main factor in the development of various chronic diseases [1-3]. With excess weight and obesity, bile is oversaturated with cholesterol, resulting in an increase of its lipogenicity index. As a result, frequency of gallstone disease increases; findings from this study document an increase of disease frequency as high as 50% to 60% [4]. In 20% of patients, housing concerns are combined with obesity [5]. Thus, obesity is one of the factors in the development of cholelithiasis and cholecystitis [6]. The presence of acute cholecystitis represents the most difficult situation for patients with gallstones. When obesity is also present, the patient's risk of surgical complications increases due to altered homeostasis and reduced reserve capacity [7]. A retrospective study of this issue [8] posed a number of questions about the possibility of influencing the course of disease in the preoperative period as well as the improvement and impact of surgical technicalities in patients with acute cholecystitis and obesity. Addressing these and additional questions is the main goal of this study. &lt;br&gt;&lt;b&gt;Aim: &lt;/b&gt;The aim of the study was to study and select the optimal method of surgery in patients with acute cholecystitis and obesity. &lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; In our study, a prospective analysis was used. We analyzed 67 cases with diagnosis of acute cholecystitis and obesity; all were treated at Kyiv Regional Clinical Hospital in the period from September 2018 to March 2020. Patients with acute cholecystitis and obesity received either traditional or modified laparoscopic cholecystectomy. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Retrospective analysis indicates traditional laparoscopic cholecystectomy is technically difficult and costly in patients with acute cholecystitis and obesity. A modified laparoscopic cholecystectomy has been proposed to improve and enhance surgery in patients with acute cholecystitis and obesity. Surgical duration was shortened by 9.01 ± 0.41 minutes (p = 0.001; αα= 0.05) when a modified laparoscopic cholecystectomy was performed. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Performing a modified laparoscopic cholecystectomy reduced the duration of surgery by 9.01 ± 0.41 minutes (p = 0.001; α = 0.05), prevents development of metabolic acidosis pH 7.39 ± 0.03 vs 7.30 ± 0.005 = 0.001; αα= 0.05, pCO2 5.05 ± 0.36 vs 6.03 ± 0.38 (p = 0.02; αα= 0.05), reducing the risk of hypercoagulation. Modified laparoscopic cholecystectomy (LHE) is effective in II and III degrees of obesity (p = 0.001; α = 0.05).

Drug-Induced Hypocoagulation: Results of Emergency Surgical Treatment

Introduction. The drug-induced hemorrhagic syndrome in surgical patients has become a serious problem of contemporary surgery, complicating the choice of treatment tactics and often leading to death. The present study is aimed at optimising emergency surgical treatment of acute cholecystitis and strangulated hernia in patients receiving warfarin. Material and methods . The study involved 18 patients with hypocoagulant state caused by warfarin (the main group). The control group (10 patients) consisted of patients taking no drugs affecting the coagulation profile. The study was conducted during 2013-2019. The range of diseases included acute cholecystitis and strangulated hernia. The scope of surgery was presented by laparoscopic cholecystectomy and cholecystectomy using minimally invasive technologies. In patients with strangulated hernias, prosthetic tension-free hernioplasty and local tissue rearrangement were used. In the main group, the INR values comprised 8.7 ± 2.8 and 8.4 ± 0.8 in the case of laparoscopic cholecystectomy and short-scar incision, respectively. In patients with strangulated hernias, the pre-surgery INR indices were 8.1 ± 2.7 and 8.0 ± 1.5 with local tissue rearrangement and prosthetic hernioplasty, respectively. The examination included: complete blood count, common urine analysis, US, endoscopic examination, etc.; in the setting of hemorrhagic syndrome, coagulogram, INR and others were added. Results and discussion. In patients with hypocoagulation syndrome, no significant differences were observed in coagu-logram parameters of the pre- and postoperative period in spite of the corrective therapy by quarantine fresh-frozen plasma. The patients with acute cholecystitis receiving warfarin demonstrated the contact bleeding of the liver and longterm serous-hemorrhagic discharge through the drains. However, the rate of hemorrhage in the group of patients with short-scar incision cholecystectomy was observed to be significantly higher as compared to the laparoscopy-operated group. In patients with strangulated hernias, in cases of drainage of the postoperative wound, a long-term serous-hemorrhagic discharge was observed. Conclusion. Laparoscopic cholecystectomy is the operation of choice in patients receiving warfarin and developing acute cholecystitis. However, in case of strangulation in patients with hernias, the optimal operation consists in local tissue rearrangement.

Percutaneous cholecystostomy – An option in selected patients with acute cholecystitis

While urgent percutaneous cholecystostomy (PC) was introduced as an alternative to acute surgical treatment for acute cholecystitis (AC), the current place of PC in the treatment algorithm for AC is challenged. We evaluate demographics and outcomes of PC in routine clinical practice in a population-based cohort.Retrospective evaluation of consecutive patients treated with PC for AC between 2000 and 2015. The severity of cholecystitis was graded according to the 2013 Tokyo Guidelines.One hundred forty-nine patients were included (82; 55% males) (median age of 72.5 years; range, 21–92). The Tokyo Guidelines criteria of 2013 (TG13) severity grade distribution was 4%, 61.7%, and 34.2% for grades I, II, and III, respectively. No difference was observed between males and females with regard to age, American Society of Anesthesiologists (ASA) score, comorbidities, or previous history of cholecystitis. PC was successfully performed in all but 1 patient, and complications were few and minor. Less than half (48.3%) of all patients subsequently received definitive surgical treatment, mostly (83.3%) laparoscopy. No or minor complications were encountered in 58 (80.6%) patients. Operated patients were significantly younger (P = <.001) and had lower ASA scores (P = .005), less comorbidities (P < .001), and had more seldomly a severe grade 3 cholecystitis (P < .001) than non-operated patients.PC is useful in selected patients with AC. However, since only a half of the patients eventually received definitive surgical treatment, a better routine decision-making based on proper criteria may enable an improved allocation of the individual patient for tailored treatment according to the disease severity, the patient's comorbidity burden, and also to the treatment options available at the institution to prevent overutilization of a non-definitive treatment approach. Comprehension of this responsibility should be acknowledged by hospitals with an emergency surgical service, although the clinical decision-making remains a challenge of the responsible surgeon on call.

PREOPERATIVE DIAGNOSTICS OF CONTRAINDICATIONS TO LAPAROSCOPIC APPROACH AT OPERATIVE TREATMENT OF ACUTE CHOLECYSTITIS

Summary. Acute cholecystitis is one of the most frequent urgent pathology – about 10-15 %.&#x0D; Purpose of the analysis – to improve the outcomes of the surgical treatment elderly and senile age patients with acute cholecystitis based on ultrasonic method investigation of a perivesical infiltration.&#x0D; Materials and method. Clinical investigation and the analysis of results of surgical treatment of acute cholecystitis at 147 patients were carried out. In all cases, cholelithiasis was the cause of acute cholecystitis. Differential criteria of the choice of surgical approach were formed before operation with the ultrasonography of a hepatopancreatoduodenal zone and color mapping with Doppler ultrasonography of a blood-circulation in a wall of a gall bladder. Depending on tissue density and spreading of inflammation, three types of infiltrate were identified: friable infiltrate, dense infiltrate with well-defined contours of a gall bladder and dense infiltrate with blurring of contours of a gall bladder and a choledoch.&#x0D; Conclusion. The research revealed the most characteristic signs of ultrasonography mapping based on which already before operation it is possible to identify contraindications to laparoscopic approach. Optimization of the choice of surgical approach allowed to increase safety of operation and to improve its results.

Применение интегрального индекса тяжести осложнений для оптимизации хирургического лечения острого холецистита легкой и средней степеней тяжести

Применение интегрального индекса тяжести осложнений для оптимизации хирургического лечения острого холецистита легкой и средней степеней тяжести

Choice of tactics of surgical treatment of acute cholecystitis and its complications

Acute cholecystitis ranks second in the incidence of urgent surgical diseases in hospitals in Ukraine. Despite a marked improvement in the treatment results, the lethality after emergency operations (9,4-37%) for acute cholecystitis complicated by peritonitis remains several times higher than with routine surgical interventions. Objectives — development of rational surgical tactics and evaluation of the effectiveness of treatment of acute cholecystitis and its complications in patients of different age groups, with different pathomorphological forms of acute cholecystitis. The result of treatment of 203 patients was presented: 75 (37,5%) were operated on an emergency basis, 73 (36,5%) urgently, and 52 (26%) in a deferred period. 173 (86.5%) patients were operated using laparoscopic technologies. Intraoperative cholangiography was performed in 16 (9,3%) patients during laparoscopic interventions. In 17 (8,5%) patients, “open” operations were performed. All patients underwent drainage of the abdominal cavity with one or more drains in view of the presence of peritonitis. The average duration of the preoperative period was 1.5 days, the total duration of treatment with LC was 4.5 days, and the total duration of treatment with OC was 10.8 days. So, in the early stages of the development of acute cholecystitis, laparoscopic cholecystectomy is effective. The use of lifting systems for laparoscopic cholecystectomy is advisable in elderly and senile patients, with concomitant diseases of the heart and lungs.

Acute cholecystitis in patients with liver cirrhosis: peculiarities of diagnosis and minimally invasive treatment

Surgical treatment of acute cholecystitis (aC) in patients with liver cirrhosis is accompanied by large number of complications. Within last 15 years, 94 patients with aC conditioned by liver cirrhosis underwent treatment in the department: 76 patients underwent laparoscopic cholecystectomy (LCE), 5 (6.2 %) – conversion to open operation. 22 patients with obstrutive jaundice firstly underwent endoscopic transpapillary procedures and in 0.1–5 days – LCE. Postoperative complications developed in 22 (27.2 %) cases: 3 (3.7 %) patients had intraab- dominal hemorrhage, 9 (11.1 %) – ascitic fluid leakage through drainage and ports, 3 (3.7 %) – oesophageal varices bleeding, 7 (8.6 %) – cardiac pulmonal and others complications. 2 (2.5 %) patients died due to the progression of hepatocellular failure, caused by bleeding from oesophageal varices after the operation. The number of intra- and postopera- tive complications can be reduced by precise ultrasound with colour doppler of hepatoduodenal region and abdominal wall, as well as by the fulfilment of the recommendations of Baveno Consensus.

DIAGNOSTIC AND SURGICAL TREATMENT OF ACUTE DESTRUCTIVE CHOLECYSTITIS IN PATIENTS WITH SUB- AND DECOMPENSATED CARDIOVASCULAR DISEASES

The work presents the indications for the choice of methods of diagnostic and surgical treatment of acute cholecystitis in patients with decompensated cardiovascular diseases. When covering the possibil- ity of diagnostic methods, their specificity and sensitivity. detailed characteristics of such instrumental techniques as ultrasonography, magnetic resonance cholangiopancreatography, magnetic tomography, echocardiography, electrocardiography, diagnostic laparoscopy has been given. The role of specific bio- chemical markers of myocardial necrosis has been showed: kretinfosfokinaza, cardiac troponin-I. Pos- sible changes on the electrocardiogram in these patients with acute cholecystitis and reasons for their appearance have been described.

хирургическая тактика при остром холецистите, осложнённом холедохолитиазом и механической желтухой

Objective: To improve the results of surgical treatment of acute cholecystitis complicated by both choledocholithiasis and obstructive jaundice. Methods: The study is based on the results of complex diagnosis and treatment of 140 patients with acute cholecystitis (AC), with complicated choledocholithiasis and mechanical jaundice. Seventy-six of patients (54.3%) had medium and severe obstructive jaundice, and 64 (45.7%) had slight mechanical jaundice. In 28 (43.75%) observations cholecystocholedocholithiasis, complicated by mechanical jaundice, was not accompanied by systemic inflammatory complications, in the remaining 36 (56.25%) observations there was cholangitis (n = 16) and biliary sepsis (n = 20). Results: Surgical approach consisted of the step-by-step approach in all 140 patients. Thus, in 64 (45.7%) observations in the presence of choledocholithiasis and mechanical jaundice, endoscopic retrograde cholangiopancreatography was performed in the first stage with an attempt of endoscopic papillosphincterotomy (EPST) and lithoextraction. In 18 cases, with phlegmonous-calculous cholecystitis and choledocholithiasis with mechanical jaundice, combined interventions were performed – percutaneous transhepatic cholecystostomy with EPST and lithoextraction. Of the 38 patients with slight mechanical jaundice, in 20 cases, the first stage was performed by percutaneoustranshepatic cholecystostomy, in 18 – by percutaneous cholecystomy through infiltration (n = 10) and drainage techniques for perivesical abscess (n = 8). In 38 cases, with gangrenous cholecystitis (n = 28), gallbladder empyema (n = 6) and local biliary peritonitis (n = 4), cholecystectomy was performed from mini-laparotomy access followed by choledocholithotomy. Conclusion: Surgical approach with AC, in complicated choledocholithiasis and in obstructive jaundice, should be differentiated and justify the implementation of phased minimally invasive surgical procedures. Keywords: Acute cholecystitis, choledocholithiasis, obstructive jaundice.

Treatment Strategies for Acute Cholecystitis of Patients with Sub- and Decompensated Cardiovascular Diseases

The work presents treatment and diagnosis for acute cholecystitis in patients with sub- and decompensated cardiovascular diseases. Th e problem of mutual deterioration between acute cholecystitis and diff erent manifestations of coronary artery disease has been reviewed. Th e main diseases of the cardiovascular system that aff ect the prognosis of acute cholecystitis have been enumerated. The role of specifi c biochemical markers of necrosis has been shown and the use of such instrumental techniques as ultrasonography, magnetic resonance cholangiopancreatography, echocardiography, electrocardiogram,diagnostic laparoscopy has discussed. Th e classifi cation of perioperative cardiovascular complications by risk — low, medium and high (L. Fleisher and K. Eagle, 1996) is used. Suffi cient detail is given to the criteria for selecting methods of surgical treatment for acute cholecystitis as well as contraindications and possible complications in the postoperative period. Refs 13. Tables 2.

Review of clinical experience with acute cholecystitis on the development of subsequent gallstone-related complications.

Recently, surgery during admission has been advocated for acute cholecystitis, rather than delayed surgery after conservative treatment. This study was designed to perform early surgeries and analyze the criteria used for conservative management followed by delayed surgery. After implementation of a study with the aim of performing early surgery, a retrospective review using a prospective database during the period of June 2009 to June 2011 was established. Early surgery during index hospitalization was offered to all patients, except those having criteria for conservative management. There were 118 patients admitted for acute cholecystitis. Early and delayed surgeries were performed for 18 (15%) and 23 (20%) patients, respectively. Percutaneous cholecystostomy was performed for 10 (8%) patients with a success rate of 90% and significantly higher length of hospital stay (P = 0.001). Gallstone-related complications developed in 33 (28%) patients, causing significantly higher readmission rates (P = 0.001). Ofthe patients, 34 (29%) were neither operated on nor had complications. The subsequent cholecystectomy rate was calculated as 35%. The overall mortality rate was 1.7% for all groups. Although surgical treatment of acute cholecystitis, either by early or delayed surgery, has some specific morbidity and mortality, it should be kept in mind that conservative treatment modalities have a higher rate of recurrences and subsequent complications, which all cause additional morbidity and mortality in patients.

老年人急性胆囊炎的60例治疗分析

目的：对老年人患急性胆囊炎的手术治疗及保守治疗结果进行分析。方法：选择急性胆囊炎老年患者60例，随机分成两组，保守组30例，进行保守治疗；手术组30例，进行手术治疗，对比两组患者的临床治疗效果。结果：手术组患者临床症状缓解时间、住院治疗时间、患者满意度均显著高于保守治疗组患者，差异具有统计学意义(P Objective: To analyze the surgical treatment of acute cholecystitis for the elderly and the conserv-ative treatment results. Methods: 60 senile patients with acute cholecystitis were selected, ran-domly divided into two groups: 30 cases of conservative treatment, 30 cases of surgical treatment. The clinical therapeutic effects of the two groups were compared. Results: Remission time of clinical symptoms, hospitalization time, and satisfaction of the patients with surgical treatment were significantly higher than those of the patients with conservative treatment. The difference was statistically significant (P

Advantages of early cholecystectomy in clinical practice of a terciary care center

Despite a number of studies show the superiority of early over delayed cholecystectomy in the treatment of acute cholecystitis, there is still controversy over the time for intervention. This study aimed to assess the use of early versus delayed cholecystectomy for the treatment of acute cholecystitis in terms of complications, conversion to open surgery and mean hospital stay. We collected patients with acute cholecystitis treated at a referral center for a year, and retrospectively analyzed the chosen therapeutic approach, the percentage of conversion of early cholecystectomy to open surgery, appearance of surgical complications, and mean hospital stay. The study included 117 patients, 44 women and 73 men, who had a mean age of 67.36+/-15.74 years. Early cholecystectomy was chosen in 31 (26.5%) and delayed cholecystectomy in 74 patients (63.2%). Of the 74 patients, 28 (37.8%) required emergency performance of delayed cholecystectomy, and 19 (25.7%) had not undergone surgery by the end of the study. While no differences were observed between early and delayed cholecystectomy in terms of surgical complications and conversion to open surgery, mean hospital stay was nevertheless significantly shorter in the early versus the delayed cholecystectomy group (8.32+/-4.98 vs 15.96+/-8.89 days). Under the routine working conditions of a hospital that is neither specially dedicated to the surgical treatment of acute cholecystitis nor provided with specific management guidelines, early cholecystectomy can reduce the hospital stay without increase of the conversion rate or complications.