Meta-analysis comparing early <i>versus</i> delayed laparoscopic cholecystectomy for acute cholecystitis

Wu, Xiaoyan; Tian, Xu; Liu, M.-M.; Wu, Lang; Zhao, ShouFa; Zhao, Lei

doi:10.1002/bjs.9886

Cited by 133 publications

(126 citation statements)

References 53 publications

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“…Although surgery may be delayed for up to 6 weeks from the acute attack, it has been advocated that patients should undergo laparoscopic cholecystectomy during emergency admission for calculous and acalculous cholecystitis [5,6]. The severity of acute cholecystitis is usually classified using the revised Tokyo Guidelines (TG13) and the extent of gallbladder inflammation has been documented to impact the surgical outcome [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

Lorenzon¹,

Costa²,

Massa³

et al. 2016

Surg Today

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Section: Introductionmentioning

confidence: 99%

The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

Lorenzon¹,

Costa²,

Massa³

et al. 2016

Surg Today

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“…In cases of acute complications, gallbladder tissue or bile for culture are not available and management options agree on supportive care and early antibiotic use, but delayed cholecystectomy and percutaneous drainage cholecystostomy remain controversial [43][44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Gallbladder microbiota variability in Colombian gallstones patients

Arteta¹,

Carvajal-Restrepo²,

Sánchez-Jiménez³

et al. 2017

J Infect Dev Ctries

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Introduction: Gallbladder stones are a very frequently occurring condition. Despite bile bactericidal activity, many bacteria have been detected inside the gallbladder, and gallstones facilitate their presence. Between 3% and 5% of the patients with Salmonella spp. infection develop the carrier stage, with the bacteria persisting inside the gallbladder, shedding bacteria in their feces without signs of infection. The aim of this study was to isolate bacteria from Colombian patients with gallstones, using standard culturing methods, and to identify Salmonella spp. carriers by molecular techniques. Methodology: A total of 149 patients (120 female and 29 male) diagnosed with gallstones who underwent cholecystectomy and who did not have symptoms of acute inflammation were included. Gallbladder tissue and bile were cultured and used for DNA extraction and Salmonella spp. hilA gene detection. Results: Of the 149 patients 28 (19%) had positive cultures. Twenty-one (75%) patients with positive cultures were from Medellin's metropolitan area. In this geographical location, the most frequent isolations were Pseudomonas spp. (38%), Klebsiella spp. (23%), and Proteus spp. (9%) in addition to unique cases of other bacteria. In Apartado, the isolates found were Enterobacter cloacae (50%), Raoultella terrigena (32%), and both Enterobacter cloacae and Raoultella terrigena were isolated in one (18%) male patient. Five (3.3%) of the 149 patients had positive polymerase chain reaction (PCR) results for the hilA gene of Salmonella spp., all of whom were female and residents of the Medellín metropolitan area. Conclusions: The gallbladder microbiota variability found could be related to geographical, ethnic, and environmental conditions.

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“…Wu et al performed a meta-analysis that found early laparoscopic cholecystectomy (within seven days of symptom onset) was associated fewer days lost from work, compared with delayed laparoscopic cholecystectomy (greater than 7 days of symptom onset). 17 For a poor, working population, the ability to return home sooner or return to work faster is an important, often overlooked factor.…”

Section: Discussionmentioning

confidence: 99%

Prolonged length of stay in delayed cholecystectomy is not due to intraoperative or postoperative contributors

Bhandari

Wilson

Rifkind

et al. 2017

Journal of Surgical Research

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Background Previous studies have reported that performing same-day laparoscopic cholecystectomy (LC) for acute cholecystitis is superior to delayed elective cholecystectomy. While this practice is ideal, it requires significant hospital resources. We sought to determine whether prolonged preoperative length of stay (LOS) was associated with increased operative time and length of stay in patients with acute cholecystitis. Methods This was a retrospective chart review of patients treated for symptomatic gallstone disease at a large municipal hospital between September 2012 and November 2013. Inclusion criteria were patients age ≥18 years who underwent same-admission cholecystectomy and had a diagnosis of cholecystitis on pathology. Medical records were reviewed and relevant data points were collected. Univariate and multivariate regressions were performed to assess the correlation between time to operation (<36hrs (no delay) or > 36hrs (delay)) and the main outcomes (operative time and total length of stay). Results 88 patients met all criteria for inclusion. Patients with > 36hrs wait prior to surgery had a total length of stay twice as long as patients with < 36hrs wait (152 vs 8.3; p=0005). Operative times were similar for patients in the delay and no delay groups (2.38 vs 2.01; p=0.1833). The mean (SD) preoperative LOS was 76.2 (±48.6) hours, the mean operative time was 2.3 (±1.1) hours and the mean postoperative LOS was 60.3 (±60.1) hrs. The average total LOS was 136 (±79.8) hrs. There was no association between preoperative and postoperative LOS. These findings remained significant when adjusted for age, sex, radiologic findings, number of preoperative tests and pathology. Conclusion Increased preoperative LOS is associated with a statistically but not clinically significant increase in operative time. It was associated with an increased total LOS for patients with acute cholecystitis who undergo same-admission cholecystectomy. The increase in total LOS was associated solely with preoperative LOS. Level of Evidence Level III Study Type Therapeutic/Care Management

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Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis

Abstract: For patients with acute cholecystitis, ELC appears as safe and effective as DLC. ELC might be associated with lower hospital costs, fewer work days lost, and greater patient satisfaction.

Cited by 133 publications

References 53 publications

The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

Gallbladder microbiota variability in Colombian gallstones patients

Prolonged length of stay in delayed cholecystectomy is not due to intraoperative or postoperative contributors

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