Timing of laparoscopic cholecystectomy in acute cholecystitis
Tóm tắt
Background Laparoscopic cholecystectomy is associated with an increased conversion rate in acute cholecystitis.
Aim To review the operative management of symptomatic cholelithiasis with particular reference to conversion rates and morbidity for laparoscopic cholecystectomy for acute cholecystitis.
Methods Patients undergoing cholecystectomy between January 1994 and December 1998 were recruited. Demographic details, diagnosis, duration of symptoms, treatment, outcome, post-operative stay and complications were recorded.
Results Complete data were available on 482 patients (84%). Laparoscopic cholecystectomy was attempted in 120 of 132 patients (91%) with acute cholecystitis and 329 of 350 patients (94%) with non-acute gallbladder disease. Conversion rates were 27% (33/120) and 6.7% (22/329) for acute and non-acute gallbladder disease, respectively (p<0.001 x2 test). Relating the interval from onset of symptoms to surgery, conversion rates for acute cholecystitis were: <3 days, 5/17 (29%); 4 to 42 days, 14/59 (23%) and >42 days, 14/44 (31%). There were three bile duct injuries, two in the delayed (>45 days) acute group and one in the non-acute group.
Conclusion Early laparoscopic cholecystectomy is the treatment of choice for acute cholecystitis, but is associated with a high conversion rate independent of the timing of surgery.
Tài liệu tham khảo
Geoghegan JG, Keane FBV. Laparoscopic management of complicated gallstone disease.Br J Surg 1999; 86: 145–6.
Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis.Lancet 1996; 347: 989–94.
Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis.Arch Surg 1996; 131: 540–5.
Lai PBS, Kwong KH, Leung KL, Kwok SPY, Chan ACW, Chung SCS, Lau WY. Randomised trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.Br J Surg 1998; 85: 764–7.
Lo CM, Liu CL, Fan ST, Lai ECS, Wong J. Prospective randomised study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.Ann Surg 1998; 227: 461–7.
Lo CM, Liu CL, Fan ST, Lai ECS, Wong J. Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.Ann Surg 1996; 223: 37–42.
Willsher PC, Sanabria JR, Gallinger S, Rossi L, Strasberg S, Litwin DE. Early laparoscopic cholecystectomy for acute cholecystitis: a safe procedure.J Gastrointest Surg 1999; 3(1): 50–3.
ShapiroAJ, Costello C, Harkabus M, North JH Jr. Predicting conversion of laparoscopic cholecystectomy for acute cholecystitis.JSLS 1999; 3(2): 127–30.
Chahin F, Elias N, Paramesh A, Saba A, Godziachvili V, Silva YJ. The efficacy of laparoscopy in acute cholecystitis.JSLS 1999; 3(2): 121–5.
Isoda N, Ido K, Kawamoto C, Suzuki T, Nagamine N, Ono K, Sato Y, Kaneko Y, Kumagai M, Kimura K, Sugano K. Laparoscopic cholecystectomy in gallstone patients with acute cholecystitis.J Gastroenterol 1999; 34(3): 372–5.
Koperna T, Kisser M, Schulz F. Laparoscopic versus open treatment of patients with acute cholecystitis.Hepatqgastroenterolqgy 1999; 46(26): 753–7.
Lee V, Chari R, Cucchiaro G, Meyers WC. Complications of laparoscopic cholecystectomy.Am J Surg 1993; 165: 527–32.
Kum CK, Goh PMY, Issac JR, et al. Laparoscopic cholecystectomy for acute cholecystitis.Br J Surg 1994; 81:1651–4.
Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis.Ann Surg 1993; 217: 233–6.