Are we performing enough emergency laparoscopic cholecystectomies? An experience from a district general hospital

Shaikh, Irshad; Sanjay, P.; Joga, Kishore; Yalamarthi, Satheesh; Daniel, Thomas M.; Amin, A.I.

doi:10.1016/j.ijsu.2009.08.002

Cited by 3 publications

(7 citation statements)

References 11 publications

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“…Bile duct injuries and other surgical complications such as bile leak and bleeding were reported at higher rates when LC was carried out in an acutely inflamed gallbladder (9,13,14,19). However, series from specialized centers reported very low to zero bile duct injury rates for early laparoscopic treatment of AC (4,8).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the timing of surgery in AC, it is accepted that a duration of the symptoms for AC of not more than 72 h is important for the safety of LC with regard to major complications and conversion rates (10)(11)(12)(13)(14)(15). Therefore, the day of onset of symptoms was accepted as a reference point in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies favored an early approach, which, when compared to delayed cholecystectomy, has similar complication rates and reduced overall length of hospital stay (LOHS) (1,(6)(7)(8)(9)(10)(11)(12). However, the early approach has not been fully implemented since only 15% to 75% of patients with AC can be operated on upon initial hospitalization for many reasons, including patient comorbidities or older age (1,4,8,(13)(14)(15)(16). It has been reported that initial conservative management followed by DS after several weeks might also cause recurrent attacks of AC and other gallstone-related complications, requiring readmissions to the hospital while waiting for surgery (10,16).…”

Section: Introductionmentioning

confidence: 99%

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

Hasbahçeci¹,

Ali̇moğlu²,

Başak³

et al. 2014

Turk J Med Sci

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Background/aim: 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. Materials and methods: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.Results: 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). Of the 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. Conclusion: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 a have higher rate of recurrences and subsequent complications, which all cause additional morbidity and mortality in patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hasbahçeci¹,

Ali̇moğlu²,

Başak³

et al. 2014

Turk J Med Sci

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“…High costs for surgical training are probably a main reason for scarce training capacity even nowadays and may lead to further reduction of tutorial assistances in case of increased competition in healthcare markets. Secondly, the study shows a remarkably low [2,6,8,9,12,[22][23][24]. In the light of working hour restrictions and repeatedly stated concerns about decreasing quality of surgical training, reduction of these lost operations could lead to earlier surgical excellence in the career of young surgical residents [25].…”

Section: Discussionmentioning

confidence: 99%

The cost of surgical training: analysis of operative time for laparoscopic cholecystectomy

et al. 2012

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Background Duration of surgery is a main cost factor of surgical training. The purpose of this analysis of operative times for laparoscopic cholecystectomies (LC) was to quantify the extra time and related costs in regards to the surgeons' experience in the operating room (OR). Methods All LC performed between January 01, 2005 and December 31, 2008 in 46 hospitals reporting to the database of the Swiss Association for Quality Management in Surgery (AQC) were analyzed (n = 10,010). Four levels of seniority were specified: resident (R), junior consultant (JC), senior consultant (SC), and attending surgeon (AS). The differences in operative time according to seniority were investigated in a multivariable log-linear and median regression analysis controlling for possible confounders. The OR costs were calculated by using a full cost rate in a teaching hospital. Results A total of 9,208 LC were available for analysis; 802 had to be excluded due to missing data (n = 212) or secondary major operations (n = 590). Twenty-eight percent of the LC were performed by R as teaching operations (n = 2,591). Compared with R, the multivariable analysis of operative time showed a median difference of -2.5 min (-9.0; 4.8) for JC and -18 min (-25; -11) for SC and -28 min (-35; -10) for AS, respectively. The OR minute costs were €17.57, resulting in incremental costs of €492 (159; 615) per operation in case of tutorial assistance. Conclusions The proportion of LC performed as tutorial assistance for R remains low. Surgical training in the OR causes relevant case-related extra time and therefore costs.

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“…1 Early cholecystectomy is a well-established procedure for acute cholecystitis. [2][3][4] However, there are no clear guidelines for the perioperative management of these patients with acute cholecystitis receiving APT and/or ACT. If a patient with mild cholecystitis is considered to be at a high risk for a thromboembolic event, cholecystectomy is often suspended until the thromboembolic risk decreases.…”

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confidence: 99%

Emergency Cholecystectomy for Patients on Antiplatelet Therapy

Akahoshi¹,

Ochiai²,

Takaoka³

et al. 2017

The American Surgeon™

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The use of antiplatelet therapy (APT) and/or anticoagulant therapy (ACT) continues to increase due to the aging population. Because the management of patients with acute cholecystitis receiving APT/ACTis still unclear, surgeons are sometimes faced with the difficult decision to delay surgery. We aimed to analyze characteristics and surgical risks of patients who underwent emergency cholecystectomy for acute cholecystitis without discontinuing APT. We conducted a retrospective review of 113 patients between 2006 and 2014. Treatment outcomes among 13 patients who underwent cholecystectomy without discontinuing APT (the cAPT group), 11 patients who discontinued APT and ACT (the D group), and 89 patients who did not receive preoperative APT and/or ACT (the No APT group) were compared. There were no significant differences in intraoperative blood loss, conversion to open surgery, and bleeding-related complications. However, the incidence of intraoperative blood transfusion was higher in the cAPT group (P = 0.04). They presented with severe local inflammation; thus, it was difficult to stop bleeding from the gallbladder bed. Hemostatic tools for liver surgery were used to control bleeding. Emergency cholecystectomy was tolerable for patients with acute cholecystitis while continuing APT. However, in case of severe local inflammation, there is a greater risk for massive hemorrhage.

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Are we performing enough emergency laparoscopic cholecystectomies? An experience from a district general hospital

Cited by 3 publications

References 11 publications

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

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

The cost of surgical training: analysis of operative time for laparoscopic cholecystectomy

Emergency Cholecystectomy for Patients on Antiplatelet Therapy

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