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Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes
OBJECTIVES: We aim to evaluate our policy of index admission management of gall bladder empyema and the effect of the timing of surgery on the outcomes. METHODS: We analyzed a series of 5400 laparoscopic cholecystectomies. Data were collected prospectively over 26 y. Patients were divided into two g...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Society of Laparoendoscopic Surgeons
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7208918/ https://www.ncbi.nlm.nih.gov/pubmed/32425482 http://dx.doi.org/10.4293/JSLS.2020.00015 |
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author | El Zanati, Hisham Nassar, Ahmad H. M. Zino, Samer Katbeh, Tarek Ng, Hwei Jene Abdellatif, Ayman |
author_facet | El Zanati, Hisham Nassar, Ahmad H. M. Zino, Samer Katbeh, Tarek Ng, Hwei Jene Abdellatif, Ayman |
author_sort | El Zanati, Hisham |
collection | PubMed |
description | OBJECTIVES: We aim to evaluate our policy of index admission management of gall bladder empyema and the effect of the timing of surgery on the outcomes. METHODS: We analyzed a series of 5400 laparoscopic cholecystectomies. Data were collected prospectively over 26 y. Patients were divided into two groups: group 1, intervention within 72 h, and group 2, intervention after 72 h of admission. We had a policy of intention to treat during the index admission, but delays sometimes occurred because of late referral, a need to optimize patients, availability of theater time, or the biliary surgeon being on leave. The groups were then compared with regard to the duration of surgery, the difficulty grading, complications, hospital stay, and conversion rate. RESULTS: A total of 372 patients were included; 160 (43%) operated on within 72 h (group 1) and 212 (57%) after 72 h (group 2). There was no statistically significant difference between the two groups with regard to the operation time, conversion rate, and complications rate. The difference in total hospital stay was, however, statistically significant. CONCLUSION: Surgical management of empyema should be offered as soon as possible after admission as with any acute cholecystitis. Surgery carried out after 72 h of admission is only associated with longer hospital stay but no statistically significant differences in other outcome parameters. In the presence of specialist expertise, fitness for surgery should be the determining factor of whether or not to offer surgery to these patients, regardless of the interval since their admission. |
format | Online Article Text |
id | pubmed-7208918 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Society of Laparoendoscopic Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-72089182020-05-18 Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes El Zanati, Hisham Nassar, Ahmad H. M. Zino, Samer Katbeh, Tarek Ng, Hwei Jene Abdellatif, Ayman JSLS Research Article OBJECTIVES: We aim to evaluate our policy of index admission management of gall bladder empyema and the effect of the timing of surgery on the outcomes. METHODS: We analyzed a series of 5400 laparoscopic cholecystectomies. Data were collected prospectively over 26 y. Patients were divided into two groups: group 1, intervention within 72 h, and group 2, intervention after 72 h of admission. We had a policy of intention to treat during the index admission, but delays sometimes occurred because of late referral, a need to optimize patients, availability of theater time, or the biliary surgeon being on leave. The groups were then compared with regard to the duration of surgery, the difficulty grading, complications, hospital stay, and conversion rate. RESULTS: A total of 372 patients were included; 160 (43%) operated on within 72 h (group 1) and 212 (57%) after 72 h (group 2). There was no statistically significant difference between the two groups with regard to the operation time, conversion rate, and complications rate. The difference in total hospital stay was, however, statistically significant. CONCLUSION: Surgical management of empyema should be offered as soon as possible after admission as with any acute cholecystitis. Surgery carried out after 72 h of admission is only associated with longer hospital stay but no statistically significant differences in other outcome parameters. In the presence of specialist expertise, fitness for surgery should be the determining factor of whether or not to offer surgery to these patients, regardless of the interval since their admission. Society of Laparoendoscopic Surgeons 2020 /pmc/articles/PMC7208918/ /pubmed/32425482 http://dx.doi.org/10.4293/JSLS.2020.00015 Text en © 2020 by JSLS, Journal of the Society of Laparoscopic & Robotic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way. |
spellingShingle | Research Article El Zanati, Hisham Nassar, Ahmad H. M. Zino, Samer Katbeh, Tarek Ng, Hwei Jene Abdellatif, Ayman Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes |
title | Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes |
title_full | Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes |
title_fullStr | Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes |
title_full_unstemmed | Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes |
title_short | Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes |
title_sort | gall bladder empyema: early cholecystectomy during the index admission improves outcomes |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7208918/ https://www.ncbi.nlm.nih.gov/pubmed/32425482 http://dx.doi.org/10.4293/JSLS.2020.00015 |
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