Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25–72 hour”? A case control study

Ambe, Peter C.; Weber, Sebastian A.; Christ, Hildegard; Wassenberg, Dirk

doi:10.1186/1749-7922-9-60

Cited by 51 publications

(33 citation statements)

References 22 publications

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“…The period of 10 days may be too long, considering the trends of the timing of early surgery in recent reports, 8,16–18 However, AC progresses from edematous cholecystitis through necrotizing cholecystitis to suppurative/subacute cholecystitis within about 10 days. 11,12 That is the reason why cases with operations performed within 10 d were regarded as “early surgery.”…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Hayama¹,

Ohtaka²,

Shoji³

et al. 2016

JSLS

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Background and Objectives:Factors that contribute to difficult laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) that would affect the performance of early surgery remain unclear. The purpose of this study was to identify such risk factors.Methods:One hundred fifty-four patients who underwent LC for AC were retrospectively analyzed. The patients were categorized into early surgery and delayed surgery. Factors predicting difficult LC were analyzed for each group. The operation time, bleeding, and cases of difficult laparoscopic surgery (CDLS)/conversion rate were analyzed as an index of difficulty. Analyses of patients in the early group were especially focused on 3 consecutive histopathological phases: edematous cholecystitis (E), necrotizing cholecystitis (N), suppurative/subacute cholecystitis (S).Results:In the early group, the CDLS/conversion rate was highest in necrotizing cholecystitis. Its rate was significantly higher than that of the other 2 histopathological types (N 27.9% vs E and S 7.4%; P = .037). In the delayed-surgery group, a higher white blood cell (WBC) count and older age showed significant correlations with the CDLS/conversion rate (P = .034 and P = .004).Conclusion:In early surgery, histopathologic necrotizing cholecystitis is a risk factor for difficult LC in AC. A higher WBC count and older age are risk factors for delayed surgery.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Hayama¹,

Ohtaka²,

Shoji³

et al. 2016

JSLS

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“…However even with significant as well as slightly better outcomes noted in ELC, the study also finds for the fact that ELC is better than DLC which is consistent with other studies. 13,14,26 Conversely, considering that two symptoms showed significant difference while the other two did not show significant difference, it can be stated that there is not statistically significant difference between ELC and DLC. This too is consistent with some findings in the literature.…”

Section: Discussionmentioning

confidence: 96%

Abdominal symptoms and its outcome in gallbladder diseases following routine and emergency cholecystectomy

Giridharan

Madhivadhanam

2017

Int Surg J

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Background: Gallstones constitute for the most common causes of biliary tract diseases in the adult population. The study thus aims to describe the persistence rate of abdominal symptoms in patients after elective cholecystectomy and to understand which symptoms, improve after cholecystectomy.Methods: This observational study is based in Melmaruvatthur Medical College and Research Institute where 69 patients were a part of the study. A pre and post structured questionnaire was used to assess the decrease in the rate of symptoms. After fully informed and written consent the study participants were interviewed questioneired, examined according to the preformed and pretested proforma, patients with a clinical and ultrasonographic diagnosis of gallstones filled out a structured questionnaire on abdominal pain symptoms and functional gastrointestinal disorder before and at six months after cholecystectomy.Results: From the observed chi square value of 9.315 and p value of 0.002 which is less than 0.01 so it is declared that there is an association between the cholecystectomy and symptoms in the post-surgical group.Conclusions: The findings of the study thus suggest that while much of the findings lean toward ELC being better than DLC, the significance values show that no difference exist between the two. The study therefore states that more research is required to ascertain whether ELC or DLC is better at reducing the symptoms associated with gall bladder disease.

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“…Depending on the duration of symptoms, this can be undertaken safely in most patients and with a low rate of conversion to an open operation. Subspecialty surgical expertise is sometimes required if gross inflammatory changes or obliteration of the peri‐ductal anatomy is encountered …”

Section: Discussionmentioning

confidence: 99%

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

Nguyen

Dijk

Smith

et al. 2019

ANZ Journal of Surgery

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Background Laparoscopic cholecystectomy (LC) is often performed during the index admission after emergency presentation for acute biliary pain. Many patients have acute cholecystitis (AC) that may increase operative difficulty and complications. Our primary aim was to assess the validity of Tokyo Guidelines (TG18) for diagnosing AC by comparison with the admitting team diagnosis, operative findings and histopathology. The secondary aim was to assess outcomes after same‐admission or delayed LC. Methods Retrospective analysis of patients who underwent LC after presenting to a tertiary hospital emergency department over a 12‐month period was conducted. Results A total of 139 patients underwent LC with no mortality or bile duct injury. A diagnosis of AC made by the admitting surgical team had sensitivity of 84% and specificity of 57%. The TG18 diagnosis had sensitivity of 84% and specificity of 53%. A diagnosis of AC by the admitting surgical team correlated well with TG18 criteria diagnosis. There was poor correlation between clinical and histopathological diagnoses. Nine percent of patients had complications and 4% required conversion to open procedure. Patients with a clinical diagnosis of AC had longer post‐operative length of stay and more complications compared with those who had non‐AC diagnosis. There was no difference in outcomes between same‐admission LC or delayed LC. Conclusion TG18 diagnosis of AC does not improve accuracy of diagnosis or predictability of a poor outcome over the admitting surgical team diagnosis. Same‐admission LC for patients with AC is associated with similar outcomes compared to those who undergo delayed LC.

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Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25–72 hour”? A case control study

Cited by 51 publications

References 22 publications

Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Abdominal symptoms and its outcome in gallbladder diseases following routine and emergency cholecystectomy

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

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