Surgical treatment of acute calculous cholecystitis followed by one-day discharge of patients

2019 ◽  
pp. 32
Author(s):  
F. S. Kurbanov ◽  
M. A. Chinikov ◽  
Yu. G. Aliev ◽  
R. Kh. Azimov ◽  
L. R. Alvendova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis

scholarly journals Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

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

THE PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF COMPLICATED FORMS OF GALLSTONE DISEASE

Vestnik ◽  
2021 ◽  
pp. 391-394
Author(s):  
В.М. Мадьяров ◽  
М.М. Сахипов ◽  
Г.Р. Жапаркулова
Keyword(s):  
Surgical Treatment ◽  
Gallstone Disease ◽  
Pathological Process ◽  
Abdominal Complications ◽  
Acute Calculous Cholecystitis ◽  
Results Of Treatment ◽  
Calculous Cholecystitis

Проанализированы за последние три года результаты оперативного лечения 200 больных с осложненными формами желчнокаменной болезни. Доказано, что риск возникновения гнойно-деструктивных форм острого калькулезного холецистита зависит от характера патологического процесса в желчном пузыре. По поводу гнойно-деструктивных форм заболевания при острого калькулезного холецистита оперировано 79,7% больных и 38,9% при необструктивной форме холецистита. Риск интраабдоминальных осложнений зависит от наличия обструкции, выявленное у 18,1% больных с обтурационнной и 5,6% у пациентов с необтурационнной формой. Госпитализация при гнойно-деструктивных формах 63,5% пациентов в первые 2 часа и 85,7% в первые 6 часов от момента заболевания, дает возможность своевременно оперировать больных до развития его интраабдоминальных осложнений. The results of treatment of 200 patients with complicated forms of gallstone disease were analyzed. It is proved that the risk of purulent-destructive forms of acute calculous cholecystitis depends on the nature of the pathological process in the gallbladder. For purulent-destructive forms of the disease in acute calculous cholecystitis, 79.7% of patients and 38.9% of patients with non-obstructive form of cholecystitis were operated on. The risk of intra-abdominal complications depends on the presence of obstruction, identified in 18.1% of patients with obstructive and 5.6% in patients with non-obstructive form. Hospitalization with purulent-destructive forms of 63.5% of patients in the first 2 hours and 85.7% in the first 6 hours from the time of the disease makes it possible to timely operate patients before the development of its intra-abdominal complications.

Mortality Risk Estimation in Acute Calculous Cholecystitis: Beyond the Tokyo Guidelines

2021 ◽  
Author(s):  
Ana-María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

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 patients for surgical treatment. The objective 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 January 1, 2011 to December 31, 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confunding 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 could allow us to create a new alternative guideline to TG for treating ACC.Trial Registration: retrospectively registered and recorded in Clinical Trials (NTC 0474441).

scholarly journals Long-term results of surgical treatment of calculous cholecystitis with the use of mini-access

2014 ◽  
Vol 21 (1) ◽  
pp. 67-69
Author(s):  
R. A. Sopiya ◽  
A. A. Popov ◽  
A. J. Korobov ◽  
E. R. Sopiya
Keyword(s):  
Surgical Treatment ◽  
Clinical Laboratory ◽  
Long Term Results ◽  
Acute Calculous Cholecystitis ◽  
Sf 36 ◽  
Instrumental Methods ◽  
Calculous Cholecystitis

The paper presents the follow-up results of the mini-access surgery for chronic calculous cholecystitis (72 patients) and for calculous cholecystitis (133 patients) performed 3-6 years ago. The long-term results were estimated on two international questionnaires of quality of life (SF-36, GSRS), and on the data of clinical, laboratory and instrumental methods of investigation. All patients operated on for chronic calculous cholecystitis had good long-term results. 99.3 % of the patients with acute calculous cholecystitis had good and satisfactory results of surgical treatment. Only 1 (0.7 %) patient had an unfavourable result, because of choledocholithiasis, identified 2 years after surgery.

scholarly journals PECULIARITIES OF THE REHABILITATION PROGRAM IN ELDERLY PATIENTS IN THE POST-OPERATIVE PERIOD WITH ACUTE CALCULOUS CHOLECYSTITIS

2021 ◽  
pp. 108-113
Author(s):  
I. K. Churpiy ◽  
V. K. Churpiy ◽  
K. L. Churpiy ◽  
N. R. Golod ◽  
L. P. Fedorivska
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Period ◽  
Rehabilitation Program ◽  
Early Postoperative Period ◽  
The Body ◽  
Maximum Efficiency ◽  
Surgical Trauma ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis

Currently, the elderly and senile account for 10 to 25% of all hospitalized for acute calculous cholecystitis. High operative-anesthetic risk, concomitant diseases and low resistance to surgical trauma are the cause of high frequency of postoperative complications and fatalities in this category of patients. In recent years, a reduction in postoperative mortality in acute cholecystitis, which is currently 0.28-2.9%, with gangrenous cholecystitis, it is higher to 17.8%. The aim of the study is to analyze and develop a rehabilitation program in the postoperative period in elderly and senile patients after surgery with acute calculous cholecystitis. Materials and methods We conducted an analysis of surgical treatment of 53 elderly and senile patients with acute calculous cholecystitis. In all patients, this diagnosis was confirmed intraoperatively and histologically. The age of all patients ranged from 61 to 89 years (mean 72.4 ± 8.7 years). Among the examined sick men there were 12 (22.6%), women - 41 (77.4%). The main criteria for assessing and creating a rehabilitation program in patients after surgery with acute calculous cholecystitis were the following processes: improving the general condition of patients, restoring intestinal motility, restoring or improving all impaired cardiovascular and respiratory functions, prevention of general complications (cardiovascular, respiratory, urinary, digestive and other systems), local (from the wound), normalization of blood parameters, One of the important components of successful surgical treatment of patients in the postoperative period is the timely restoration of respiratory, cardiovascular, digestive system after surgery. a guarantee of prevention of probable postoperative complications which are formed in the first 3-5 days after surgery. Objectives of the rehabilitation program in the early postoperative period in elderly and senile patients with acute calculous cholecystitis: to reduce the impact of drugs and accelerate the excretion of toxic substances from the body; restore adequate respiration and oxygen saturation; improve external respiration function, bronchial patency and bronchial drainage function; stabilize central hemodynamics to reduce peripheral circulatory disorders; prevent complications from the gastrointestinal tract, thromboembolic complications; prevent complications from the postoperative wound. Conclusions: Development of a rehabilitation program is a mandatory component in operated patients. Particular attention is paid to elderly and senile patients, who require a set of rehabilitation measures to be minimal, but sufficient to restore lost or reduced body functions in the early postoperative period, but at the same time, it should not exceed the patient's capabilities and ensure maximum efficiency. restoration. Start a rehabilitation program (breathing exercises, kinesiotherapy, massage, inhalation in combination with physiotherapy procedures) should be 12 - 16 hours after surgery. Prospects for further development Continue to develop a rehabilitation program for elderly and senile patients, taking into account the functional capabilities of the body in the long period of rehabilitation.

scholarly journals FEATURES OF SURGICAL TACTICS OF TREATMENT OF ACUTE CALCULOUS CHOLECYSTITIS OCCURRING AGAINST THE BACKGROUND OF DIABETES MELLITUS

2018 ◽  
Vol 25 (6) ◽  
pp. 90-95
Author(s):  
V. V. Zorik ◽  
G. K. Karipidi ◽  
A. V. Morozov
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Histological Study ◽  
Open Cholecystectomy ◽  
Control Group ◽  
Acute Calculous Cholecystitis ◽  
Patients With Diabetes ◽  
Calculous Cholecystitis

Aim. The study was conducted to improve the results of the surgical treatment of acute calculous cholecystitis occurring against the background of diabetes mellitus. Materials and methods. In course of our study, we analyzed the treatment results of 687 patients with acute calculous cholecystitis. Depending on the presence of diabetes, all patients were divided into two groups. The main group with concomitant diabetes mellitus included 68 (9,9%) patients, whereas the control group without diabetes included 619 (90,1%) patients. Laparoscopic cholecystectomy was performed on 636 (92,6%) patients, and open cholecystectomy was performed on 51 (7,4%) patients. Results. According to the histological study, the greatest number of destructive forms occurs in patients with concomitant diabetes, operated after 24 hours. The least postoperative complications occur in patients of both groups operated from 12 to 24 hours. However, the incidence of complications is 4-5 times higher in patients with diabetes mellitus. Postoperative complications in patients with acute calculous cholecystitis occurring on the background of sugar diabetes were observed after open cholecystectomy in 33,3% of cases and in 6,5% of cases after laparoscopic surgery.Conclusion In patients with acute cholecystitis and concomitant diabetes, surgical treatment should be performed on the first day after the preoperative preparation during the first 12 hours, aimed at compensating for diabetes and improving microcirculation. The preference should be given to laparoscopic cholecystectomy, which reduces the number of postoperative complications by 5 times and mortality by 4.5 times.

scholarly journals ANTIBIOTIC PROPHYLAXIS OF PURULENT AND SEPTICAL COMPLICATIONS DURING SURGICAL TREATMENT OF COMPLICATED GALLSTONE DISEASE ON BACKGROUND OF LIVER CIRRHOSIS

2019 ◽  
Vol 42 (3) ◽  
pp. 41-45
Author(s):  
Khimich S. D. ◽  
Muravyev F. T.
Keyword(s):  
Liver Cirrhosis ◽  
Surgical Treatment ◽  
Antimicrobial Prophylaxis ◽  
Gallstone Disease ◽  
Mirizzi Syndrome ◽  
Acute Calculous Cholecystitis ◽  
Escalation Therapy ◽  
Group 2 ◽  
Calculous Cholecystitis ◽  
Group 1

Purpose of the study. The goal of this investigation was to determine the main risk factors in development of purulent and septical complications during surgical treatment of complicated gallstone disease on background of liver cirrhosis. Materials and methods. We retrospectively reviewed medical records of 247 patients who undergone treatment in minimally invasive surgery centre of Zhytomyr regional clinical hospital during 2009–2018. All patients with complicated gallstone disease were divided in two groups: group 1 – patients with concomitant liver cirrhosis – 79(31,98%), and group 2 – patients without liver cirrhosis – 168 (68,02%). The inclusion criteria were presents of complicated gallstone disease (acute calculous cholecystitis, choledocholithiasis with obstructive jaundice and Mirizzi syndrome), and verified liver cirrhosis. Patients with oncological history, immunodeficiency and morbid obesity were excluded. Liver cirrhosis was staged by Child-Тurcotte-Рugh system. In all cases patient’s condition was assessed by APACHE II scoring system and patients with cirrhotic lesion were additionally analyzed by MELD score. Acute calculous cholecystitis was diagnosed in 185 patients: group 1 – 68(Child A – 36, Child B – 31, Child C – 1), group 2 – 117 patients. The signs of cholodecholithiasis with obstructive jaundice were present in 49 cases: group 1 – 7 (Child A – 5, Child B – 1, Child C – 1), group 2 – 42. Mirizzi syndrome was verified in 9 cases: group 1 – 2 (Child A – 1, Child B – 1, group 2 – 7. Results and discussion. In all patients treatment was started in conservative way that included detoxic, antibacterial and hepatoprotective components. In group of control early operative tactic in cases with acute calculous cholecystitis was preferred. Antimicrobial prophylaxis was performed in cases of severe and moderate calculous cholecystitits with use of cephalosporines of 2 generation in moderate case, and protected cephalosporines of 3 generation in combination with metronidazol in severe. In main group providing of antimicrobial therapy was performed very carefully, because of higher risk of hepato-renal insufficiency. The early de-escalation therapy was mandatory performed. Purulent complications occurred in 13,2% of patient with liver cirrhosis in comparison with control group with 1,7% of complications. Conclusion. The treatment of complicated gallstone disease in patients with liver cirrhosis is very risky in case of postoperative purulent complications. In case of Child A stage of cirrhosis the treatment is safe, and the incidents of purulent complications is the same like in the absence of cirrhosis. Administration of antibiotics in cirrhotic should be very careful because of higher risk of hepato-renal insufficiency. The early de-escalation therapy should be mandatory performed. The «gold» standard of empirical antimicrobial therapy is the use of cephalosporines of 2 and 3 generation. Keywords: gallstone disease, cirrhosis, antimicrobial prophylaxis.

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