Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

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Extended antibiotic therapy versus placebo after laparoscopic cholecystectomy for mild and moderate acute calculous cholecystitis: A randomized double-blind clinical trial

Surgery ◽

10.1016/j.surg.2018.01.014 ◽

2018 ◽

Vol 164 (1) ◽

pp. 24-30 ◽

Cited By ~ 7

Author(s):

Martín de Santibañes ◽

Juan Glinka ◽

Pablo Pelegrini ◽

Fernando A. Alvarez ◽

Cristina Elizondo ◽

...

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Antibiotic Therapy ◽

Double Blind ◽

Acute Calculous Cholecystitis ◽

Double Blind Clinical Trial ◽

Calculous Cholecystitis

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Efficacy of acute laparoscopic cholecystectomy for acute calculous cholecystitis regardless the length of symptoms

Laparoscopic Endoscopic Surgical Science ◽

10.14744/less.2017.21931 ◽

2017 ◽

Author(s):

Marek Soltes

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Calculous Cholecystitis ◽

Calculous Cholecystitis

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Comparison of laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in aged acute calculous cholecystitis: a cohort study

Surgical Endoscopy ◽

10.1007/s00464-019-07091-4 ◽

2019 ◽

Vol 34 (7) ◽

pp. 2994-3001

Author(s):

Dengtian Lin ◽

Shuodong Wu ◽

Ying Fan ◽

Changwei Ke

Keyword(s):

Cohort Study ◽

Laparoscopic Cholecystectomy ◽

Acute Calculous Cholecystitis ◽

Delayed Laparoscopic Cholecystectomy ◽

Calculous Cholecystitis

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Nondrainage after Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis Does Not Increase the Postoperative Morbidity

BioMed Research International ◽

10.1155/2018/8436749 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Jianguo Qiu ◽

Ming Li

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Postoperative Recovery ◽

End Points ◽

Acute Calculous Cholecystitis ◽

Vas Score ◽

Estimated Blood Loss ◽

Number Of Patients ◽

Significant Difference ◽

Calculous Cholecystitis

Background. It is now established that prophylactic drainage is not needed after laparoscopic cholecystectomy (LC) for chronic calculous cholecystitis. However, the benefit of drains versus their potential harm for acute calculous cholecystitis (ACC) following laparoscopic LC has been questioned. Therefore, we conducted a comparative study to assess the need for drainage.Methods. Between January 2014 and October 2016, 212 patients with ACC undergoing LC undergo either drainage (n= 106) or no drainage (n= 106). The primary end points were the number of patients with postoperative drain-related complications, early and late Visual Analogue Scale (VAS) score, and hospital stay. Secondary end points included estimated blood loss, postoperative recovery, analgesia requirement, and cosmetic satisfaction result.Results. There was no bile duct injury and mortality in both groups. The overall complication rate was 12.5% with no significant difference between those with or without drainage (P=0.16). Normal activity resumption was significantly faster and the postoperative hospital stay was slightly shorter in the nondrainage group (P=0.03 andP= 0.04, respectively). The early VAS score in the drainage group was significantly higher (p<0.05). There were no significant differences between the two groups in postoperative hematology test, late VAS score, and patient satisfaction of cosmetic outcome.Conclusion. Routine drainage for patients with ACC after LC may not be justified with similar drain-related complications compared with nondrainage group.

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