Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: Protocol of a systematic review and meta-analysis of results

Abstract

Background: Early laparoscopic cholecystectomy has been adopted as the treatment of choice for acute cholecystitis due to a shorter hospital length of stay and no increased morbidity when compared to delayed cholecystectomy. However, randomised studies and meta-analysis report a wide array of timings of early cholecystectomy, most of them set at 72 h following admission. Setting early cholecystectomy at 72 h or even later may influence analysis due to a shift towards a more balanced comparison. At this time, the rate of resolving acute cholecystitis and the rate of ongoing acute process because of failed conservative treatment could be not so different when compared to those operated with a delayed timing of 6-12 weeks. As a result, randomised comparison with such timing for early cholecystectomy and meta-analysis including such studies may have missed a possible advantage of an early cholecystectomy performed within 24 h of the admission, when conservative treatment failure has less potential effects on morbidity. This review will explore pooled data focused on randomised studies with a set timing of early cholecystectomy as a maximum of 24 h following admission, with the aim of verifying the hypothesis that cholecystectomy within 24 h may report a lower post-operative complication rate compared to a delayed intervention. Methods: A systematic review of the literature will identify randomised clinical studies that compared early and delayed cholecystectomy. Pooled data from studies that settled the early intervention within 24 h from admission will be explored and compared in a subgroup analysis with pooled data of studies that settled early intervention as more than 24 h. Discussion: This paper will not provide evidence strong enough to change the clinical practice, but in case the hypothesis is verified, it will invite to reconsider the timing of early cholecystectomy and might promote future clinical research focusing on an accurate definition of timing for early cholecystectomy for acute cholecystitis.

Defining the Scope of Antimicrobial Stewardship Interventions on the Prescription Quality of Antibiotics for Surgical Intra-Abdominal Infections

“…Uncomplicated cholecystitis with an indication for surgery warrants no antibiotics beyond the operating room, unless there are criteria such as perforation, gangrene or empyema defining complicated cholecystitis; uncomplicated diverticulitis is usually managed medically, and surgical diverticulitis (e.g., perforated diverticulitis) is proposed to be treated postoperatively for 4 days, providing that source control has been adequate [ 27 ]. In our study, there was a trend towards a shortened duration of postoperative EAT, but the difference was not significant expect for the treatment duration in cholecystitis, in compliance with current guidelines [ 28 , 29 ]. To address this matter of the extended continuation of postoperative antibiotics, our AMS team developed hospital-specific guidelines on medical and surgical IAIs, a multidisciplinary effort with the joint participation of the departments of general surgery, hepatology and gastroenterology.…”

The burden of the pandemic on the non-SARS-CoV-2 emergencies: A multicenter study

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“…In COVID-19 patients, the metabolic alterations were also detectable in the recycle system. 90 , 91 By performing proteomic and metabolomic profiling of sera from COVID-19 (n = 46) and control individuals (n = 53), Shen et al revealed characteristic protein and metabolite changes in the sera of severe COVID-19 patients, which might be used in selection of potential blood biomarkers for severity evaluation. 92 The serum metabolites of COVID-19 patients were also evaluated to investigate metabolic effects of SARS-CoV-2 infection which identified that amino acid (tryptophan, gluconeogenic and sulfur-containing amino acid) and fatty acid (acylcarnitines and free fatty acids) metabolism are correlated with COVID-19 disease.…”