Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis

Bickel, Amitai; Hoffman, Rotem Sivan; Loberant, Norman; Weiß, Michael; Eitan, Arie

doi:10.1007/s00464-015-4290-y

Cited by 37 publications

(24 citation statements)

References 27 publications

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“…Therefore, PC followed by delayed LC should be considered in elderly patients and those in higher ASA classes to reduce morbidity. When considering the indication for PC, one study showed that the common comorbidities were hypertension (76%), ischemic heart disease (54%), diabetes (37%), and renal failure (22%) [16]. We obtained similar results in our study.…”

Section: Discussionsupporting

confidence: 87%

Percutaneous cholecystostomy for acute cholecystitis in high‐risk elderly patients

Lin

Chang

Chu

2016

The Kaohsiung J of Med Scie

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Emergency cholecystectomy for acute cholecystitis (AC) is associated with high morbidity and mortality rates in elderly patients with significant comorbidities. The aim of this study was to evaluate percutaneous cholecystostomy for AC in elderly patients with various coexisting diseases. We retrospectively reviewed the records of 4311 patients with AC treated in Mackay Memorial Hospital between the years 2000 and 2015. The clinical course of AC was compared between nonelderly (age ≤70 years) and elderly patients (age>70 years). In total, 67 elderly patients and 32 nonelderly patients received percutaneous cholecystostomy. The rate of percutaneous cholecystostomy increased between the years 2011 and 2015 (from 2.5% to 12.2%) and this procedure was more common in the elderly group (p=0.009). In addition, the comorbidities of ischemic heart disease and chronic kidney disease were higher in elderly than in nonelderly patients (p=0.014 and p=0.015, respectively). The American Society of Anesthesiologists' classification was higher in the elderly patients (p=0.001). The overall survival-free rate of recurrent cholecystitis in patients who did not receive cholecystectomy was not significantly different in the two groups. When compared with emergent cholecystectomy in high-risk elderly patients, percutaneous cholecystostomy resulted in reduced hospital stay and morbidity (p=0.002 and p=0.013, respectively). Our results demonstrate that percutaneous cholecystostomy has become a common and early treatment for AC in high-risk elderly patients with ischemic heart disease or chronic kidney disease. Identifying such patients will possibly improve clinical outcomes, reduce hospital stay and morbidity, and facilitate delayed laparoscopic cholecystectomy.

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Section: Discussionsupporting

confidence: 87%

Percutaneous cholecystostomy for acute cholecystitis in high‐risk elderly patients

Lin

Chang

Chu

2016

The Kaohsiung J of Med Scie

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“…We believed that our criteria for difficult cholecystectomy were appropriate. Although BMI, CRP, and the interval between symptom onset and PTGBD were suggested as independent risk factors for difficult cholecystectomy [17–21], these parameters did not differ between difficult and non-difficult cholecystectomy cases in this study.…”

Section: Discussioncontrasting

confidence: 51%

Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis

et al. 2017

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BackgroundThe Tokyo guideline for acute cholecystitis recommended percutaneous transhepatic gallbladder drainage followed by cholecystectomy for severe acute cholecystitis, but the optimal timing for the subsequent cholecystectomy remains controversial.MethodsSixty-seven patients who underwent either laparoscopic or open cholecystectomy after percutaneous transhepatic gallbladder drainage for severe acute cholecystitis were enrolled and divided into difficult cholecystectomy (group A) and non-difficult cholecystectomy (group B). Patients who had one of these conditions were placed in group A: 1) conversion from laparoscopic to open cholecystectomy; 2) subtotal cholecystectomy and/or mucoclasis; 3) necrotizing cholecystitis or pericholecystic abscess formation; 4) tight adhesions around the gallbladder neck; and 5) unsuccessfully treated using PTGBD. Preoperative characteristics and postoperative outcomes were analyzed.ResultsThe interval between percutaneous transhepatic gallbladder drainage and cholecystectomy in Group B was longer than that in Group A (631 h vs. 325 h; p = 0.031). Postoperative complications occurred more frequently when the interval was less than 216 h compared to when it was more than 216 h (35.7 vs. 7.6%; p = 0.006).ConclusionsCholecystectomy for severe acute cholecystitis was technically difficult when performed within 216 h after percutaneous transhepatic gallbladder drainage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-017-0631-8) contains supplementary material, which is available to authorized users.

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“…6 Many studies have also reported a higher incidence of difficult LC and higher rate of conversion to OC in male patients. [7][8][9] Similar gender bias was also evident in results obtained in this study inspite of the smaller sample size considered. This may be due to the fact that males more frequently suffer from acute and chronic cholecystitis and have higher quantities of intra-abdominal and visceral adipose tissues in comparison to females.…”

Section: Discussionsupporting

confidence: 84%

Assessment of clinical, hematological, radiological parameters for prediction of difficult laparoscopic cholecystectomy at a tertiary health care centre

2018

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Background: Since its introduction in the mid 1980’s, laparoscopic cholecystectomy (LC) has been widely used for symptomatic cholelithiasis. In recent years it has been considered as a gold standard for treatment of symptomatic cholelithiasis. Recent studies have reported that the rate of conversion of LC to open cholecystectomy (OC) is 1.5-19%. The aim of the present study was to predict the difficulties of performing laparoscopic cholecystectomy in symptomatic cholelithiasis. Further, the possibility of converting LC to open cholecystectomy was also investigated using various haematological, clinical, and radiological tool such as USG.Methods: The present prospective study was conducted in in Nehru Hospital of BRD Medical College, Gorakhpur, India over a period of 12 months on in-patients from various surgical wards undergoing LC. The patients were primarily divided into two groups consisting of those undergoing LC and those converted to OC respectively. Parameters like gender, age, body mass index, associated complains, total leukocyte count (TLC) and levels of alkaline phosphatase (ALP) were assessed as potential risk factors for conversion.Results: 50 patients were considered for this study. Results indicated that rate of conversion of LC to OC was found to be maximum for patients belonging to male gender, 31-40 years old, were obese, had previous history of upper abdominal surgery and had raised levels of TLC and ALP. Patients having multiple stones and contracted gall bladder also had a higher incidence of conversion to OC.Conclusions: From results obtained in this study, it could be concluded that parameters like age, gender, obesity, history of upper abdominal surgery, raised levels of TLC and ALP, incidences of multiple stones and contracted gall bladder posed significant risk for LC and acted as predictors for conversion to OC.

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Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis

Cited by 37 publications

References 27 publications

Percutaneous cholecystostomy for acute cholecystitis in high‐risk elderly patients

Percutaneous cholecystostomy for acute cholecystitis in high‐risk elderly patients

Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis

Assessment of clinical, hematological, radiological parameters for prediction of difficult laparoscopic cholecystectomy at a tertiary health care centre

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