scholarly journals Acute cholecystitis - early or delayed cholecystectomy

2002 ◽  
Vol 55 (3-4) ◽  
pp. 135-139 ◽  
Author(s):  
Goran Petakovic ◽  
Milan Korica ◽  
Sava Gavrilovic
Keyword(s):  
Sick Leave ◽  
Acute Cholecystitis ◽  
Late Results ◽  
Chronic Cholecystitis ◽  
Home Treatment ◽  
Endocrine Surgery ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Group I ◽  
Group Ii

Introduction In our population biliary tract diseases are the most frequent surgical entity. If the diagnosis of acute cholecystitis is relatively clear and the time from onset of the disease does not exceed 72 hours, early cholecystectomy is recommended. The aim of i his prospective study was to use certain analytical procedures in order to compare early and late results of early and delayed cholecystectomy. Material and methods 240 patients were divided into two groups: Group 1: patients treated by early cholecystectomy and Group II: patients treated by delayed cholecystectomy. We compared the following: intraoperative findings, postoperative morbidity and mortality complications, average number of patient-days and histopathological changes. Results During the investigated period (1998-1999), 599 (35,95%) patients with acute and 1.067 (64.05%) patients with chronic cholecystitis were treated at the Clinic of Abdominal and Endocrine Surgery of the Clinical Center Novi Sad. Out of 599 patients with acute cholecystitis, 489 (81.63%) patients underwent surgery, whereas 1S0 (18.37%) were treated conservatively. In regard to chronic cholecystitis, 963 (90.25%) patients were surgically treated, and 104 (9.75%) patients were conservatively treated. All patients from Group I were operated within 24-48 hours from onset of the disease or during 24 hours of hospitalization. They were hospitalized due to signs of cholecystitis for the first time, whereas this was the second hospitalization for all patients from Group II, 42?2.3 days after first hospitalization on average. Regarding sick leave in Group I patients it was calculated as follows: hospital days + home treatment and it made 32?3.7 days. In Group II it was calculated as follows: first hospitalization + home treatment + second hospitalization + home treatment making 53?6.7 days. Conclusions The number and type of early and late complications in Group II patients justifies early cholecystectomy; in acute cholecystitis, cholecystectomy should be performed within 24 - 48 hours from the onset of the disease; in regard to late, early cholecyslectomies are characterized by significantly shorter period of recovery and sick leave.

scholarly journals Early versus delayed cholecystectomy in acute cholecystitis: a comparative study in a tertiary care hospital

2020 ◽  
Vol 7 (8) ◽  
pp. 2656
Author(s):  
Jamal Uddin Ahmed ◽  
Subal Rajbongshi ◽  
Najim Hiquemat
Keyword(s):  
Acute Cholecystitis ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Definitive Treatment ◽  
P Value ◽  
Care Hospital ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Surgery Group ◽  
Duration Of Surgery

Background: For patients with acute cholecystitis the timing of operative intervention has two broad approaches- early cholecystectomy and elective or delayed cholecystectomy. The main advantage of early cholecystectomy is that, it offers a definitive treatment during the same admission and avoids the problem of failed conservative treatment. The present study is an endeavour to discuss and to compare the outcome of management of acute cholecystitis with early and delayed cholecystectomy.Methods: 100 patients with clinical diagnosis of acute cholecystitis, admitted in the surgical wards of Gauhati Medical College and Hospital during the period of 1st July 2017 to 30th June 2018 were selected for the study. 40 patients underwent early cholecystectomy (within 7 days of onset of symptoms) and 60 patients underwent elective or late cholecystectomy (after a gap of 6-8 weeks from the acute attack).Results: In the present series the average duration of surgery was 90.37±11.96 minutes in the early group and 65.3±7.83 minutes for the elective group which is found to be statistically significant (p value<0.05). In the early surgery group 8.33% required conversion to open surgery. In the elective surgery group 3.63% required conversion. Wound infection, biliary leakage, bile duct injury, and respiratory tract infection was found to be statistically not significant between the two groups.Conclusions: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system.

scholarly journals The Effect of Leucocytosis, Gender Difference, and Ultrasound in the Diagnosis of Acute Cholecystitis in the Elderly Population

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Arda Demirkan ◽  
Ayça Koca Tanrıverdi ◽  
Arda Çetinkaya ◽  
Onur Polat ◽  
Müge Günalp
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Acute Cholecystitis ◽  
Blood Cells ◽  
White Blood Cells ◽  
Young Patients ◽  
The Elderly ◽  
Quadrant Pain ◽  
Group I ◽  
Group Ii

Introduction. Acute cholecystitis is one of the most common reasons of acute abdominal pain for older patients to present to the emergency department (ED). Presentation may differ from that of the younger patient and is often complicated by coexistent disease due to elderliness. In this study, we aimed to evaluate the clinical presentation of acute cholecystitis, with special focus on comparision between elderly and young patients. Materials and Methods. This study included 318 patients who were admitted to the emergency department with right upper quadrant pain during a period of determined 8 months. After retrospective data collection, patients were groupped in accordance with their age, <65 and ≥65 years. Those who had ultrasonographic signs such as wall thickening and fluid collection were diagnosed as acute cholecystitis. Results. The young group (Group I) consisted of 225 patients, 132 females and 93 males. In Group I, 39 patients were diagnosed as acute cholecystitis of whom 27 were females and 15 were males. The elderly group (Group II) consisted of 93 patients 48 females and 45 males. In Group II, 36 patients were diagnosed as acute cholecystitis of whom 15 were females and 21 were males. Regarding the diagnosis of acute cholecystitis, the female to male ratio is 2.25 in Group I and 0.71 in Group II (p=0.016). The average white blood cells counts of patients with acute cholecystitis in Group I and in Group II were 9907x109/L(±4.437) and 17083x109/L(±7485), respectively (p<0,001). Conclusions. Acute cholecystitis is a common diagnosis in elderly patients with right upper quadrant pain. It is more frequent in female in the early ages, but the gender difference tends to change with age. Elderly patients demonstrate a higher level of white blood cells when compared to young patients in acute cholecystitis. Clinicians must maintain a degree of awareness in the evaluation of geriatric patients with right upper quadrant abdominal pain.

scholarly journals Laparoscopic versus open splenectomy in the management of hematologic diseases

2003 ◽  
Vol 58 (5) ◽  
pp. 243-249 ◽  
Author(s):  
Manuela V. Sapucahy ◽  
Joel Faintuch ◽  
Cláudio J.C. Bresciani ◽  
Pedro L. Bertevello ◽  
Angelita Habr-Gama ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Open Surgery ◽  
Late Results ◽  
Thrombocytopenic Purpura ◽  
Hematologic Diseases ◽  
Laparoscopic Procedures ◽  
Group I ◽  
The Mean ◽  
Group Ii

Splenectomy is the best available treatment for severe forms of hereditary spherocytosis, idiopathic thrombocytopenic purpura, and other hematologic conditions when these prove refractory to conservative management. It has been employed for many decades with low mortality and favorable remission rates. The use of laparoscopic splenectomy in recent years has been rapidly and even enthusiastically adopted in this field. However, the exact role of laparoscopic versus open surgery for hematologic diseases is still debated. In this study of 58 adult patients, laparoscopic procedures were compared with conventional splenectomies for similar indications. METHODS: All patients were operated on within an 8-year period. Subjects underwent similar procedures under the supervision of the same surgical school and were compared regarding age, gender, body mass index, and diagnosis. Laparoscopically managed cases (Group I, n = 30) were prospectively followed according to a written protocol, whereas the same investigation was retrospectively done with regard to traditional laparotomy (Group II, n = 28). Methods included general and demographic findings, duration and technical steps of operation, blood loss, weight of spleen, need for conversion (in minimally invasive subjects), intraoperative and postoperative complications, time until realimentation, postoperative hospitalization, mortality, and late follow-up including recurrence rate. RESULTS: Idiopathic thrombocytopenic purpura was the surgical indication in over 50% of the patients in both groups, but familial spherocytosis, thalassemia, myelodysplasia, and lymphomas were also represented in this series. Laparoscopic procedures took more time to perform (P = 0.004), and postoperative hospitalization was 2 days shorter, but this difference was not statistically significant. Postoperative hematocrit and volume of blood transfusions was equivalent, although the laparoscopic cases had a somewhat lower preoperative hematocrit (NS) and displayed better recovery for this measurement (P = 0.03). More patients in Group I were able to accept oral food on the first day than subjects undergoing conventional operations (P < 0.05). Relatively few conversions were necessary during the minimally invasive surgeries (13.3%), and postoperative early and late complications as well as recurrences occurred in similar proportions. Also, the mean weight of the spleen was not statistically different between the groups, although there was a marked numerical tendency toward larger masses in conventional procedures. No spleen in Group I exceeded 2.0 kg, whereas in Group II values up to 4.0 kg occurred, and the mean weight was 50% higher in the latter group. CONCLUSIONS: 1) Minimally invasive splenectomy was essentially comparable to open surgery with regard to safety, efficacy, and late results; 2) Advantages concerning shorter postoperative hospitalization could not be shown, despite earlier food intake and a non-significant tendency toward earlier discharge; 3) This new modality should be considered an option in cases of hematologic conditions whenever the spleen is not hugely enlarged.

scholarly journals Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis

HPB Surgery ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Miguel Sánchez-Carrasco ◽  
Juan C. Rodríguez-Sanjuán ◽  
Fernando Martín-Acebes ◽  
Francisco J. Llorca-Díaz ◽  
Manuel Gómez-Fleitas ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Cost Savings ◽  
Direct Costs ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Appropriate Treatment ◽  
Costs Of Treatment ◽  
Hospital Morbidity

Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.

scholarly journals Results of transplantation of the hepatic right part from living familial donor

2019 ◽  
Vol 86 (5) ◽  
pp. 17-21
Author(s):  
О. G. Коtenko ◽  
А. А. Minich ◽  
О. V. Hrynenko ◽  
О. О. Popov ◽  
А. V. Gusev ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Vascular Complications ◽  
Postoperative Mortality ◽  
Late Results ◽  
Morbidity Rate ◽  
Surgical Morbidity ◽  
Septic Complications ◽  
Group I ◽  
Group Ii ◽  
The Impact

Objective. To estimate the immediate and late results in recipients while transplantation of the hepatic right part with median hepatic vein and without her. Маterials and methods. Postoperative data about 86 patients, to whom the hepatic right half was transplanted in 2003 - 2018 yrs., with the objective to estimate the impact of presence of median hepatic vein in the transplant on the morbidity rate development, were analyzed. The patients were divided into two groups: Group I - the patients, to whom the hepatic right half was transplanted without median hepatic vein, while Group II - the patients, to whom the hepatic right half was transplanted with median hepatic vein. Results. The investigation have revealed a higher rate of vascular complications in patients, to whom the hepatic right half was transplanted without median hepatic vein, comparing with the patients, to whom the hepatic right half was transplanted with median hepatic vein. The infection-septic complications have developed more frequently in patients, to whom the hepatic right part was transplanted without median hepatic vein. Nonspecific surgical morbidity developed in 10 (23.3%) patients of the Group I and in 8 (18.6%) patients of the Group II. The rate of development of the small hepatic transplant syndrome was higher in the Group I. Оne-year, two-year and five-year survival in the Group I have constituted 79, 72 and 69% accordingly, in the Group II - 83, 74 and 70% accordingly. Conclusion. Our experience of performance of the hepatic right half transplantation witnesses, that presence of median hepatic vein in the transplant correlates with lowering of the postoperative morbidity rate, as well as with frequency of development the small hepatic transplant syndrome, postoperative mortality and the stationary stay duration.

scholarly journals Bacteriological examination of gallbladder contents

2002 ◽  
Vol 55 (5-6) ◽  
pp. 225-228 ◽  
Author(s):  
Goran Petakovic ◽  
Milan Korica ◽  
Sava Gavrilovic
Keyword(s):  
Escherichia Coli ◽  
Acute Cholecystitis ◽  
Endocrine Surgery ◽  
Bacteriological Examination ◽  
Venous Flow ◽  
E Coli ◽  
Gallbladder Mucosa ◽  
Microbial Sensitivity Tests ◽  
Group I ◽  
Sensitivity Tests

Introduction Acute calculous (obstructive) cholecystitis develops as a consequence of cystic obstruction and obstruction of bile flow into choledochus. Most often it is a result of impacted gallstones in Hartman's pouch or the cystic duct. Their direct pressure on gallbladder mucosa causes ischemia, necrosis and ulceration with consequential wall edema and obstructed venous flow. This mechanism is further increasing and spreading the inflammatory process. Ulcerations may be that extensive, that mucosa is highly recognizable on the microscopic preparation. Leukocyte infiltration of all segments occurs. Results of necrosis are as follows: perforation with pericholecystic abscess formation, fistulization or biliary peritonitis. Aim The aim of this investigation was to use microbial sensitivity tests in order to establish possibilities of antibiotic therapy in patients with acute cholecystitis. Material and methods Using random sampling a total of 240 patients with acute cholecystitis were included in the investigation. They were all treated at the Clinic of Abdominal and Endocrine Surgery of the Clinical Center Novi Sad in the period 1997-1999. All patients underwent bacteriological examination and were coherent in regard to sex and age. Microbial sensitivity tests analyzed two groups of bacteria: Group I Escherichia coli, Klebsiella and Staphylococcus and Group II: other isolated bacteria (Citrobacter, Enterobacter, Enterococcus, Proteus, Pseudomonas Serratia and Streptococcus). Results In our material Escherichia coli was isolated in most patients - 32 (55.17%), Klebsiella and Staphylococcus in 6 (10.34%) patients and Streptococcus in 4 (6.90%), whereas other bacteria were infrequent (Citrobacter and Serratia in 3.45%, Enterobacter, Proteus and Pseudomonas in 1.75%). Thus, E. coli, Klebsiella and Staphylococcus were established in 75.85% of bacteriologic findings, and all the rest in 24.15%. Assessment regarding premedication with antibiotics started with an assumption that cholecystitis was caused by one of the bacteria isolated in 75% of cases. That is why antibiotics should be given prior to surgery primarily those to which these bacteria are susceptible in more than 95% of cases. Conclusions E. coli, Klebsiella and Staphylococcus participate with 75.85% of all bacteriologic findings, whereas all the others make 24.15% Amikacin, Cefalexin, Ceftriaxone, Ofloxacin and Pefloxacin are recommended in premedication; considering the fact that new generation antibiotics have not been tested yet, they were not taken into consideration for this study.

Late Results of Aortic Valve Replacement with Bjork Shiley Prostheses: A Comparison of Standard Aortic Valve Prosthesis with Reversed Mitral Valve Prosthesis Implanted in Aortic Position

1989 ◽  
Vol 12 (11) ◽  
pp. 728-732
Author(s):  
T.K. Kaul ◽  
J.L. Mercer
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Late Results ◽  
Valve Prosthesis ◽  
Mitral Valve Prosthesis ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Between 1976 and 1983, 435 patients underwent aortic valve replacement (AVR) with Bjork Shiley prostheses. Standard aortic Bjork Shiley prostheses (ABP) were used in 150 patients (Group I) and a reversed mitral Bjork Shiley prostheses in 285 (MBP in 250 and MBC in 35) patients (Group II). There was no significant difference in the number of the patients with valve calcification or the size of aortic root in the 2 groups. There was no significant difference in the early mortality in these two groups. The total follow up period in Group I was 912 years and 2130 years in Group II. The incidence of major aseptic prosthetic dehiscence and valve occlusion with tissue ingrowth were higher in Group I than in Group II. Reversed Bjork Shiley mitral valve prosthesis was successfully used in aortic position with reduced incidence of valve related complications.

scholarly journals Comparative Evaluation of the Quality Of Life Of Patients after the Pressible-Transparent Cholecismostomy аnd "Traditional" Cholecismostomy with Thermal Mucoclasion of the Gold Bubble

2017 ◽  
Vol 10 (3) ◽  
pp. 236-240
Author(s):  
Maxim Borisovich Polyansky ◽  
Dmitry Petrovich Nazarenko ◽  
Tatjana Aleksandrovna Ishunina ◽  
Dmitrii Igorevich Kolmykov
Keyword(s):  
Quality Of Life ◽  
Acute Cholecystitis ◽  
Psychological Health ◽  
Statistical Processing ◽  
Role Functioning ◽  
Group I ◽  
Sf 36 ◽  
Group Ii ◽  
Microsoft Office

Relevance. The number of elderly patients with acute cholecystitis is constantly increasing, in spite of the success achieved in the diagnosis and treatment of this pathology. The possibilities for radical treatment of patients with high operational anesthesia risk are substantially limited. The aim of the study was to conduct comparative analysis of the quality of life of patients after transcutaneous-transhepaticmicrocholecystostomy and traditional cholecystostomy with thermal mucoclasia of the gallbladder. Materials and methods. The quality of life of 31 patients with high operational anesthesia risk following transcutaneous-transhepaticmicrocholecystostomy (TTMC) and traditional cholecystostomy with thermal mucoclasia of the gallbladder (TCTMG), was studied. All patients were divided into two groups: the first group consisted of 20 (64.5%) patients who underwent TTMC, the second one included 11 (35.5%) patients who underwent TCTMG. Quality of life of patients was studied with the help of the questionnaire using the SF-36 Health Status Survey 4 months after TTMC or TCTMG. Statistical processing of the results was carried out using the program Microsoft Office Excel -2013. Results and its discussion. The physical component of health (physical functioning, role functioning due to physical condition, pain intensity, general health) was 64.25% higher in patients of Group II than in patients of Group I (p = 0.001), and the psychological Health component (mental health, role functioning due to emotional state, social functioning, vital activity) was also (68.05%) higher in Group II (p = 0.004).   Conclusions. The use of the method of thermal mucoclasia of the gallbladder in patients with high operational anesthesia risk allows to achieve higher quality indices compared to patients who underwent TTMC, since after demucotization of the gallbladder cavity it is obliterated due to hyperplasia of the connective tissue of the lamina propria or submucosa, thereby finally solving the problem of acute cholecystitis in this category of patients.

scholarly journals Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yunxiao Lyu ◽  
Ting Li ◽  
Bin Wang ◽  
Yunxiao Cheng
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Medical Costs ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Group Ii

AbstractThere is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis (AC). We retrospectively evaluated patients who underwent LC after PTGBD between 1 February 2016 and 1 February 2020. We divided patients into three groups according to the interval time between PTGBD and LC as follows: Group I (within 1 week), (Group II, 1 week to 1 month), and Group III (> 1 month) and analyzed patients’ perioperative outcomes. We enrolled 100 patients in this study (Group I, n = 22; Group II, n = 30; Group III, n = 48). We found no significant difference between the groups regarding patients’ baseline characteristics and no significant difference regarding operation time and estimated blood loss (p = 0.69, p = 0.26, respectively). The incidence of conversion to open cholecystectomy was similar in the three groups (p = 0.37), and we found no significant difference regarding postoperative complications (p = 0.987). Group I had shorter total hospital stays and medical costs (p = 0.005, p < 0.001, respectively) vs Group II and Group III. Early LC within 1 week after PTGBD is safe and effective, with comparable intraoperative outcomes, postoperative complications, and conversion rates to open cholecystectomy. Furthermore, early LC could decrease postoperative length of hospital stay and medical costs.

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