Emergency Cholecystectomy for Patients on Antiplatelet Therapy

2017 ◽  
Vol 83 (5) ◽  
pp. 486-490 ◽  
Author(s):  
Keiichi Akahoshi ◽  
Takanori Ochiai ◽  
Ayumi Takaoka ◽  
Takuya Kitamura ◽  
Daisuke Ban ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Acute Cholecystitis ◽  
Antiplatelet Therapy ◽  
Open Surgery ◽  
Massive Hemorrhage ◽  
Intraoperative Blood Loss ◽  
Local Inflammation ◽  
Conversion To Open Surgery ◽  
Difficult Decision ◽  
Emergency Cholecystectomy

The use of antiplatelet therapy (APT) and/or anticoagulant therapy (ACT) continues to increase due to the aging population. Because the management of patients with acute cholecystitis receiving APT/ACTis still unclear, surgeons are sometimes faced with the difficult decision to delay surgery. We aimed to analyze characteristics and surgical risks of patients who underwent emergency cholecystectomy for acute cholecystitis without discontinuing APT. We conducted a retrospective review of 113 patients between 2006 and 2014. Treatment outcomes among 13 patients who underwent cholecystectomy without discontinuing APT (the cAPT group), 11 patients who discontinued APT and ACT (the D group), and 89 patients who did not receive preoperative APT and/or ACT (the No APT group) were compared. There were no significant differences in intraoperative blood loss, conversion to open surgery, and bleeding-related complications. However, the incidence of intraoperative blood transfusion was higher in the cAPT group (P = 0.04). They presented with severe local inflammation; thus, it was difficult to stop bleeding from the gallbladder bed. Hemostatic tools for liver surgery were used to control bleeding. Emergency cholecystectomy was tolerable for patients with acute cholecystitis while continuing APT. However, in case of severe local inflammation, there is a greater risk for massive hemorrhage.

scholarly journals Early Laparoscopic Cholecystectomy with Continuous Pressurized Irrigation and Dissection in Acute Cholecystitis

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
I. Ozsan ◽  
O. Yoldas ◽  
T. Karabuga ◽  
U. M. Yıldırım ◽  
H. Y. Cetin ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Acute Cholecystitis ◽  
Symptom Onset ◽  
Open Surgery ◽  
Bile Leak ◽  
Conversion To Open Surgery ◽  
Conversion Rates ◽  
Pressurized Irrigation ◽  
Dissection Technique

Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis.Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded.Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was46.3±6.7years. The median time from symptom onset to hospital admission 3.2 days (range, 1–6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group.Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates.

scholarly journals Laparoscopic cholecystostomy tube placement

2020 ◽  
Vol 10 (3) ◽  
pp. 70-72
Author(s):  
 Abhiman Cheeyandira
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Surgery ◽  
Tube Placement ◽  
Safe Alternative ◽  
Excessive Bleeding ◽  
Conversion To Open Surgery ◽  
The World ◽  
Cholecystostomy Tube ◽  
Laparoscopic Cholecystostomy

Laparoscopic cholecystectomy is one of the most common procedures performed in the world today Acute calculus cholecystitis is the most frequent complication of cholelithiasis. Laparoscopic cholecystectomy is the best treatment for acute calculus cholecystitis when performed within 72 hours. Acute cholecystitis tends to be one of the highest risks for conversion to open surgery-due to unclear anatomy, excessive bleeding or technical complications. Here we present 2 cases with severe acute cholecystitis that required placement of laparoscopic cholecystostomy (LC) tube. Patient subsequently underwent interval cholecystectomy, when the inflammation had subsided. LC tube placement can be a safe alternative in such situations to avoid complications and conversion to open procedure.

scholarly journals The Correlation between Specific Biochemical Parameters, Radiological data and clinical sings for practicing laparoscopic cholecystectomy in the first 24 hours for acute cholecystitis. How safe it is?

2019 ◽  
Vol 70 (5) ◽  
pp. 1746-1749
Author(s):  
Dan Alin Brebu ◽  
Cristian Vlad ◽  
Cristi Tarta ◽  
Amadeus Dobrescu ◽  
Iuliana Mihail ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Safe Procedure ◽  
Conversion To Open Surgery ◽  
Radiological Data ◽  
Study Results ◽  
Timing Of Cholecystectomy ◽  
Emergency Cholecystectomy

The best timing of cholecystectomy on patients with acute gallbladder pathology is still unclearly defined. Some studies have reported that cholecystectomy during the index acute admission presents an increased morbidity rate, extended duration of stay and increased costs. The study below is aiming at finding the most accurate moment to practice the surgery when acute cholecystitis is confirmed. Consequently, 368 patients admitted to hospital from January 2013 to December 2015 with the diagnosis of acute cholecystitis (AC) who underwent cholecystectomy in the 2nd Department of Surgery, Emergency County Hospital, Timi�oara, Romania constituted the two lots. The cases were retrospectively identified, introduced into the database and the data were subsequently analyzed according to various parameters. The study results reveal that laparoscopic cholecystectomy (LC) in the first 24 hours is safe procedure on the majority of the cases. Also, our findings sustain that emergency cholecystectomy can reduce the length of hospital stay, having similar rates of conversion to open surgery, complications and outcome compared with a delayed operation.

scholarly journals Timing and Clinical Efficacy of Laparoscopic Cholecystectomy for Acute Cholecystitis at Different Stages

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Hao Zhang
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Clinical Efficacy ◽  
Clinical Data ◽  
Symptom Onset ◽  
Open Surgery ◽  
Surgical Trauma ◽  
Conversion To Open Surgery ◽  
Group A ◽  
Group B

Objective: To investigate timing and clinical efficacy of laparoscopic cholecystectomy for acute cholecystitis at different stages. Methods: Clinical data of 100 acute cholecystitis patients admitted to our hospital from March 2018 to March 2019 were retrospectively analyzed. Clinical data of 48 patients who had surgery within 72 hours of symptom onset were classified as group A, and clinical data of 52 patients who had surgery at ? 72 hours of symptom onset were classified as group B. Clinical indicators, rate of conversion to open surgery, and complication were compared between the two groups. Results: Length of hospital stay, operation time, exhaust time and intraoperative blood loss in group A were lower than those in group B, and the differences were statistically significant (P<0.05). Comparison of rate of conversion to open surgery between group A (2.08%, 1/48) and group B (7.69%, 4/52) showed no statistically significant difference (P>0.05). Incidence of postoperative complication was 8.33% (4/48) in group A and 11.54% (6/52) in group B, the difference was not statistically significance (P>0.05). Conclusions: Laparoscopic cholecystectomy within 72 hours of symptom onset has better efficacy than after 72 hours for patients with acute cholecystitis. It could effectively reduce surgical trauma and promote recovery.

FACTORS INFLUENCING THE OPERATION TECHNIQUE OF PEFORATED DUODENAL ULCER REPAIR BY SINGLEPORT LAPAROSCOPIC SURGERY

2016 ◽  
pp. 99-105
Author(s):  
Huu Tri Nguyen ◽  
Loc Le ◽  
Doàn Van Phu Nguyen ◽  
Nhu Thanh Dang ◽  
Thanh Phuc Nguyen
Keyword(s):  
Duodenal Ulcer ◽  
Laparoscopic Surgery ◽  
Correlation Coefficient ◽  
Open Surgery ◽  
Operative Time ◽  
Single Port ◽  
Time Correlation ◽  
Patch Repair ◽  
Perforated Duodenal Ulcer ◽  
Conversion To Open Surgery

Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer. The aim of this study was to evaluate technical factors for perforated duodenal ulcer repair by SPLS. Methods: A prospective study on 42 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue university of medicine and pharmacy hospital and Hue central hospital from January 2012 to February 2015. Results: The mean age was 48.1 ± 14.2 (17 - 79) years. 40 patients were treated with suture of the perforation by pure SPLS. There was one case (2.4%) in which one additional trocar was required. Conversion to open surgery was necessary in one patient (2.4%) in which the perforation was situated on the posterior duodenal wall. Two patients (4.8%) with history of abdominal surgery were successfully treated by pure SPLS. The size of perforation was correlated with suturing time (correlation coefficient r = 0.459) and operative time (correlation coefficient r = 0.528). Considering suture type, X stitches were used in 95.5% cases, simple stitches were used in one case (2.4%) while Graham patch repair technique was utilized in one case (2.4%) with large perforation. Most cases (95.1%) required only simple suture without omental patch. Peritoneal drainage was spared in most cases (90.2%). Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer. Posterior duodenal location is the main cause of conversion to open surgery. Factor related to operative time is perforation size. Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

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