Cargando…

Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients

BACKGROUNDS/AIMS: There is debate on the timing of cholecystectomy in acute cholecystitis. Although there is a recent trend toward early laparoscopic cholecystectomy (eLC), that is, within 72 hours of symptom onset, some surgeons still prefer delayed operations, or operations after several weeks, ex...

Descripción completa

Detalles Bibliográficos
Autores principales: Lee, Whanbong, Kwon, Jungnam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association of Hepato-Biliary-Pancreatic Surgery 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304498/
https://www.ncbi.nlm.nih.gov/pubmed/26155215
http://dx.doi.org/10.14701/kjhbps.2013.17.2.60
_version_ 1782354114486730752
author Lee, Whanbong
Kwon, Jungnam
author_facet Lee, Whanbong
Kwon, Jungnam
author_sort Lee, Whanbong
collection PubMed
description BACKGROUNDS/AIMS: There is debate on the timing of cholecystectomy in acute cholecystitis. Although there is a recent trend toward early laparoscopic cholecystectomy (eLC), that is, within 72 hours of symptom onset, some surgeons still prefer delayed operations, or operations after several weeks, expecting subsidence of the inflammation and therefore a higher chance of avoiding open conversion and minimizing complications. Our experience of LC for 10 years was reviewed retrospectively for the timing of the operation and perioperative outcomes, focusing on evaluating the feasibility of delayed LC (dLC). METHODS: The severity of the acute cholecystitis was classified into three grades: easily responding to antibiotics and mostly symptom-free (mild, grade I), symptoms persisting during the treatment (moderate, grade II), and worsening into a septic state (severe, grade III). RESULTS: Among 353 cholecystectomy patients, grade I (N=224) patients had eLC in 152 cases and dLC in 72 cases. Grade II (N=117) patients had eLC in 103 cases and 12 had dLC. All grade III patients (N=12) underwent open cholecystectomy. In Grade I patients, when the operation was delayed, there were fewer open conversion cases compared to eLC patients (20.45% vs 7.69%) (p<0.05), and complications also were decreased (p>0.05). Grade II patients' rate of open conversions (58.3% vs 44.2%) and complications (25.0% vs 19.5%) increased when the operations were delayed compared with eLC patients (p<0.05). In grade I and II patients, the most common reason for open conversion was bleeding, and the most common complication was also bleeding. CONCLUSIONS: For patients with cholecystits that easily responds to antibiotics (grade I), dLC showed a higher laparoscopic success rate than eLC at the expense of prolonged treatment time and examinations, With moderate to severe cholecystitis (grade II, III), however, there was no room for delayed operations.
format Online
Article
Text
id pubmed-4304498
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Korean Association of Hepato-Biliary-Pancreatic Surgery
record_format MEDLINE/PubMed
spelling pubmed-43044982015-07-07 Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients Lee, Whanbong Kwon, Jungnam Korean J Hepatobiliary Pancreat Surg Original Article BACKGROUNDS/AIMS: There is debate on the timing of cholecystectomy in acute cholecystitis. Although there is a recent trend toward early laparoscopic cholecystectomy (eLC), that is, within 72 hours of symptom onset, some surgeons still prefer delayed operations, or operations after several weeks, expecting subsidence of the inflammation and therefore a higher chance of avoiding open conversion and minimizing complications. Our experience of LC for 10 years was reviewed retrospectively for the timing of the operation and perioperative outcomes, focusing on evaluating the feasibility of delayed LC (dLC). METHODS: The severity of the acute cholecystitis was classified into three grades: easily responding to antibiotics and mostly symptom-free (mild, grade I), symptoms persisting during the treatment (moderate, grade II), and worsening into a septic state (severe, grade III). RESULTS: Among 353 cholecystectomy patients, grade I (N=224) patients had eLC in 152 cases and dLC in 72 cases. Grade II (N=117) patients had eLC in 103 cases and 12 had dLC. All grade III patients (N=12) underwent open cholecystectomy. In Grade I patients, when the operation was delayed, there were fewer open conversion cases compared to eLC patients (20.45% vs 7.69%) (p<0.05), and complications also were decreased (p>0.05). Grade II patients' rate of open conversions (58.3% vs 44.2%) and complications (25.0% vs 19.5%) increased when the operations were delayed compared with eLC patients (p<0.05). In grade I and II patients, the most common reason for open conversion was bleeding, and the most common complication was also bleeding. CONCLUSIONS: For patients with cholecystits that easily responds to antibiotics (grade I), dLC showed a higher laparoscopic success rate than eLC at the expense of prolonged treatment time and examinations, With moderate to severe cholecystitis (grade II, III), however, there was no room for delayed operations. Korean Association of Hepato-Biliary-Pancreatic Surgery 2013-05 2013-05-31 /pmc/articles/PMC4304498/ /pubmed/26155215 http://dx.doi.org/10.14701/kjhbps.2013.17.2.60 Text en Copyright © 2013 by The Korean Association of Hepato-Biliary-Pancreatic Surgery http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Lee, Whanbong
Kwon, Jungnam
Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients
title Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients
title_full Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients
title_fullStr Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients
title_full_unstemmed Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients
title_short Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients
title_sort delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304498/
https://www.ncbi.nlm.nih.gov/pubmed/26155215
http://dx.doi.org/10.14701/kjhbps.2013.17.2.60
work_keys_str_mv AT leewhanbong delayedlaparoscopiccholecystectomyaftermorethan6weeksoneasilycontrolledcholecystitispatients
AT kwonjungnam delayedlaparoscopiccholecystectomyaftermorethan6weeksoneasilycontrolledcholecystitispatients