Year 2022 / Volume 114 / Number 4
Original
Days of symptoms and days of hospital admission before surgery do not influence the results of cholecystectomy in moderate acute calculous cholecystitis—Cholecystectomy remains the best treatment

213-218

DOI: 10.17235/reed.2020.7405/2020

Jaume Tur-Martínez, Alfredo Escartín, Pablo Muriel, Marta González, Elena Cuello, Ana Pinillos, Helena Salvador, Jorge Juan Olsina,

Abstract
Background and Aims: early cholecystectomy is the gold-standard treatment for acute calculous cholecystitis (ACC), although many surgeons still prefer delayed cholecystectomy for grade II to avoid surgical complications. The aim of this study was to analyze the postoperative morbidity and mortality of Tokyo Guidelines grade-II ACC as treated with cholecystectomy, taking into account the days of symptoms and days since hospital admission. Materials and Methods: a unicenter, retrospective study was performed based on a prospective database. Patients with grade-II ACC treated with cholecystectomy were selected. Patients were analyzed according to days of symptoms (DS) and days of hospital admission (DHA) until cholecystectomy. Patients were subdivided into 3 groups: < 3 days, 3-5 days, and > 5 days. Univariate and multivariate analyses were performed for morbidity and mortality. Categorical variables were compared using the Chi-squared or Fischer's exact test. Continuous variables were compared using the Mann-Whitney U-test. The level of statistical significance was set at p < 0.05. Results: a total of 998 patients with ACC diagnosis were included; 567 with grade-II ACC and 368 treated with cholecystectomy. Nearly 90 % were treated laparoscopically and 48.1 % underwent surgery the same day of emergency admission. With regard to DS and DHA, there were no statistical differences for severe postoperative complications, although a greater number of complications were detected in the > 5 DS group (p: 0.32) and > 5 DHA group (p: 0.00). Statistically significant differences were found in DS for mortality (p: 0.04). Postoperative length of stay was longer for > 5 DHA group cholecystectomies (p > 0.05). There were no differences with regard to hospital readmission. Conclusion: with regard to DS or DHA until cholecystectomy, there were no statistically significant differences related to severe postoperative complications, length of stay, or mortality.
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References
1. Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:73-86.
2. Gurusamy K, Samraj K, Gluud C, et al. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010;97:141-50.
3. Wu XD, Tian X, Liu MM, et al. Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2015;102:1302-13.
4. Haltmeier T, Benjamin E, Inaba K, et al. Early versus delayed same-admission laparoscopic cholecystectomy for acute cholecystitis in elderly patients with comorbidities. J Trauma Acute Care Surg 2015;78:801-7.
5. Cao AM, Eslick GD, Cox MR. Early Cholecystectomy Is Superior to Delayed Cholecystectomy for Acute Cholecystitis: a Meta-analysis. J Gastrointest Surg 2015;19:848-57.
6. Agrawal R, Sood KC, Agarwal B. Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis. Surg Res Pract 2015;2015:1-7.
7. De Mestral C, Hoch JS, Laupacis A, et al. Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost: A Model-Based Cost-Utility Analysis. J Am Coll Surg 2016;222:185-94.
8. Roulin D, Saadi A, Di Mare L, et al. Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule? A randomized trial. Ann Surg 2016;264:717-22.
9. Okamoto K, Suzuki K, Takada T, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2018;25:55-72.
10. Kamalapurkar D, Pang TCY, Siriwardhane MH, et al. Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe. ANZ J Surg 2015;85:854-9.
11. Zafar SN, Obirieze A, Adesibikan B, et al. Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg 2015;150:129-36.
12. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:17-30.
13. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. Ann Surg 2004;240:205-13.
14. Murray AC, Markar S, Mackenzie H, et al. An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK. Surg Endosc 2018;32:3055-63.
15. Polo M, Duclos A, Polazzi S, et al. Acute Cholecystitis-Optimal Timing for Early Cholecystectomy: a French Nationwide Study. J Gastrointest Surg 2015;19:2003-10.
16. Escartín A, González M, Pinillos A, et al. Failure to perform index cholecystectomy during acute cholecystitis results in signi fi cant morbidity for patients who present with recurrence. Int Hepato-Pancreato-Biliary Assoc 2019;21:876-82.
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Tur-Martínez J, Escartín A, Muriel P, González M, Cuello E, Pinillos A, et all. Days of symptoms and days of hospital admission before surgery do not influence the results of cholecystectomy in moderate acute calculous cholecystitis—Cholecystectomy remains the best treatment. 7405/2020


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Publication history

Received: 13/07/2020

Accepted: 16/10/2020

Online First: 03/12/2020

Published: 07/04/2022

Article revision time: 79 days

Article Online First time: 143 days

Article editing time: 633 days


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