The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks

Blohm, My; Österberg, Johanna; Sandblom, Gabriel; Lundell, Lars; Hedberg, Mats; Enochsson, Lars

doi:10.1007/s11605-016-3223-y

Cited by 63 publications

(55 citation statements)

References 25 publications

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“…[4,5] In a recent large Swedish series by Blohm et al, concluded early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality with caption 'the sooner, the better'. [6] Similarly in our study, complication rates and operating difficulties were lesser in patients who were operated in the initial period and patients on long waiting period suffered relapse of symptoms and required readmissions. Our study also concludes that early intervention reduces complications and length of hospital stay.…”

Section: Discussionsupporting

confidence: 78%

IMPACT OF TIMING OF SURGERY & ROUTINE BILIARY SAMPLING IN ACUTE CALCULOUS CHOLECYSTITIS

Chitrambalam¹,

Udhayam²,

Chandrasekar³

et al. 2016

jemds

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BACKGROUND Aims and objectives -A rise has been noted in the incidence of gallstone disease and their associated complications. This clinical study was conducted with the aim of analysing the various aspects of gall stone diseases focusing on the timing of surgery, and intraoperative biliary sampling correlated to the complication rates in acute calculous cholecystitis. MATERIALS AND METHODS50 cases of acute calculous cholecystitis were evaluated with respect to incidence, clinical presentation, comorbidities, timing of surgery, operative difficulty, post-operative complications, hospital stay, bile culture, histopathology and stone analysis. RESULTSThe overall incidence of gall stones in patients was 0.7% of all hospital admissions. The mean age group was 43.92 years with a female to male ratio of 2.13:1. Right hypochondrial and epigastric pain were the most common presenting complaints. Preoperative evaluation with ultrasonogram showed a good correlation with the per-operative findings in 80% of cases. All cases underwent laparoscopic cholecystectomy. Operative difficulty was least when surgery was done within three weeks from the time of presentation. 24% cases had intra-operative complications. Escherichia coli was the most common organism grown in bile culture and there was a statistical significance between positive bile culture and post-operative complications. Pure cholesterol stones were less common on histopathological examination. CONCLUSIONEarly surgical intervention in cholecystitis reduces complications, length of hospital stay and relapse of symptoms during waiting period for surgery. The study suggests routine sampling of bile for bacterial culture and stone analysis in all cholecystectomy cases.

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Section: Discussionsupporting

confidence: 78%

IMPACT OF TIMING OF SURGERY & ROUTINE BILIARY SAMPLING IN ACUTE CALCULOUS CHOLECYSTITIS

Chitrambalam¹,

Udhayam²,

Chandrasekar³

et al. 2016

jemds

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“…Efforts to improve safety in LC have greatly increased the body of knowledge regarding all factors relevant to cholecystectomy. These include timing of the procedure and patient selection [19][20][21][22] as well as training and assessment of surgeons performing LC [23]. Endeavors to increase safety of the procedure resulted in optimized intraoperative processes, such as photographic documentation [24] of the 'critical view of safety' (CVS), first described by Strasberg and colleagues almost 20 years ago [25].…”

Section: Prevention Of Bile Duct Injuriesmentioning

confidence: 99%

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Renz¹,

Bösch²,

Angele³

2017

Visc Med

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Background: Iatrogenic bile duct injuries (IBDI) after laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery. The most important aspect regarding this issue is the prevention of IBDI during index cholecystectomy. Once it occurs, early and accurate diagnosis of IBDI is very important for surgeons and gastroenterologists, because unidentified IBDI may result in severe complications such as hepatic failure and death. Laboratory tests, radiological imaging, and endoscopy play an important role in the diagnosis of biliary injuries. Methods: This review summarizes and discusses the current literature on the management of IBDI after LC from a surgical point of view. Results and Conclusion: In general, endoscopic techniques are recommended for the initial diagnosis and treatment of IBDI and are important to classify them correctly. In patients with complete dissection or obstruction of the bile duct, surgical management remains the only feasible option. Different surgical reconstructions are performed in patients with IBDI. According to the available literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and is recommended by most authors. Long-term results are most important in the assessment of effectiveness of IBDI treatment. Apart from that, adequate diagnosis and treatment of IBDI may avoid many serious complications and improve the quality of life of our patients.

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“…Blohm in sodelavci so analizirali podatke iz švedskega nacionalnega registra pri 87.108 bolnikih, ki so bili operirani zaradi akutnega holecistitisa (30). Osredinili so se na zaplete ob in po operaciji.…”

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

“…Ugotovili so, da je tveganje za zaplete po operaciji statistično značilno nižje, če so bolniki operirani znotraj štirih dni od sprejema v bolnišnico, in da je tudi manj preklopov v klasično operacijo znotraj tega časa. Pri bolnikih, ki so jih operirali v prvih štirih dneh po sprejemu v bolnišnico, so opazovali okoli 16,6 % preklopov iz laparoskopske v klasično operacijo ter 27,8 % pri bolnikih, ki so bili operirani kasneje (30). Izguba krvi med operacijo je bila pri obeh skupinah bolnikov primerljiva, več pa je bilo poškodb žolčnih vodov pri tistih bolnikih, ki so bili operirani pozno.…”

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

“…Izguba krvi med operacijo je bila pri obeh skupinah bolnikov primerljiva, več pa je bilo poškodb žolčnih vodov pri tistih bolnikih, ki so bili operirani pozno. Avtorji zaključuje-jo, da naj bi bil optimalni čas operacije znotraj 48 ur od sprejema, če pa so bolniki operirani po 96 urah od sprejema, je tveganje za zaplete ob in po operaciji večja (30).…”

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

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Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Janež¹

2018

SlovMedJour

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IzvlečekAkutno vnetje žolčnika oziroma akutni holecistitis je pogosta bolezen, ki večkrat zahteva sprejem v bolnišnico in kirurško zdravljenje. Najpogosteje se pojavlja pri ljudeh, ki imajo žolčne kamne, pojavi pa se lahko tudi v odsotnosti žolčnih kamnov. Diagnozo akutnega holecistitisa postavimo na osnovi klinične slike, laboratorijskih izvidov in ultrazvoka trebuha. Algoritmi za bolnike, ki imajo akutno vnetje žolčnika brez pridruženih bolezni, so znani; odločitev za kirurški poseg pri bolnikih s pridruženimi boleznimi pa je odvisna od več dejavnikov. Laparoskopska holecistektomija je metoda izbire zdravljenja bolnikov z akutnim holecistitisom. Rezultati zdravljenja so bistveno boljši, kadar kirurški poseg napravimo znotraj 72 ur od nastopa kliničnih znakov.V prispevku so predstavljena najnovejša priporočila za obravnavo bolnikov z akutnim holecistitisom, povzeta po smernicah iz Tokia ter smernicah Svetovnega združenja za urgentno kirurgijo iz leta 2016 ter na koncu še izsledki in izkušnje nekaterih kliničnih študij in metaanaliz. AbstractAcute cholecystitis is a common disease, which often requires admission to hospital and surgical treatment. Acute cholecystitis is defined as inflammation of the gallbladder and usually occurs due to cystic duct obstruction from stones or sludge. It is a relatively common complication of gallstones, but it can also occur without gallstones. A combination of relevant clinical symptoms and ultrasound evidence is required to make a diagnosis of acute cholecystitis. Early surgery is recommended for all patients that are in good physical condition. There is still a debate how to treat high-risk and critically ill patients. Laparoscopic cholecystectomy is the method of choice for treatment of patients with acute cholecystitis. Early laparoscopic cholecystectomy should be done within 72 hours from the onset of symptoms. This article presents current guidelines according to the Tokyo guidelines and the World Society of Emergency Surgery guidelines, and at the end, experiences of some clinical trials. UvodAkutno vnetje žolčnika oziroma akutni holecistitis je pogosto bolezen, ki velikokrat zahteva bolnišnično zdravljenje in operacijo. Najpogosteje se pojavlja pri ljudeh z žolčnimi kamni, lahko pa tudi brez njih (1). Vnetje žolčnika brez prisotnosti kamnov je pogostejše pri kritično bolnih, ki so dlje časa na parenteralni prehrani, pri politravmatiziranih bolnikih, pri večjih opeklinah in pri bolnikih po srčnih operacijah (2). Akutni holecistitis je še posebej pogost vzrok

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The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks

Cited by 63 publications

References 25 publications

IMPACT OF TIMING OF SURGERY & ROUTINE BILIARY SAMPLING IN ACUTE CALCULOUS CHOLECYSTITIS

IMPACT OF TIMING OF SURGERY & ROUTINE BILIARY SAMPLING IN ACUTE CALCULOUS CHOLECYSTITIS

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

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