Does early surgery imply a critical risk for patients with Grade III acute cholecystitis?
early surgery
laparoscopic cholecystectomy
severe acute cholecystitis
Journal
Asian journal of endoscopic surgery
ISSN: 1758-5910
Titre abrégé: Asian J Endosc Surg
Pays: Japan
ID NLM: 101506753
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
17
01
2020
revised:
27
02
2020
accepted:
02
03
2020
pubmed:
25
3
2020
medline:
28
8
2021
entrez:
25
3
2020
Statut:
ppublish
Résumé
For patients with Grade III acute cholecystitis (AC), several factors have been proposed in the 2018 Tokyo guidelines as caution signs in performing early surgery. However, these factors have not been externally validated in detail. This retrospective study examined 35 patients who had been diagnosed with Grade III AC and treated with laparoscopic cholecystectomy between January 2008 and July 2019. The patients were allocated into an early group (patients who underwent surgery within 7 days of admission, n = 28) and a delayed group (patients who underwent surgery at least 8 days after admission, n = 7). Comparisons were made between these groups. No patients died. Significantly more patients required a conversion to open surgery (0% vs 28.5%, P = .003) or conversion to subtotal cholecystectomy (25.0% vs 71.4%, P = .020) in the delayed group than in the early group, and the total length of postoperative stay was significantly longer in the delayed group (11.4 vs 27.2 days, P = .001). The presence of negative predictive factors or risk factors listed in the 2018 Tokyo guidelines was not associated with death or postoperative complications. Early surgery was considered appropriate and feasible for select patients who had Grade III AC and preoperative risk factors.
Sections du résumé
BACKGROUND
BACKGROUND
For patients with Grade III acute cholecystitis (AC), several factors have been proposed in the 2018 Tokyo guidelines as caution signs in performing early surgery. However, these factors have not been externally validated in detail.
METHODS
METHODS
This retrospective study examined 35 patients who had been diagnosed with Grade III AC and treated with laparoscopic cholecystectomy between January 2008 and July 2019. The patients were allocated into an early group (patients who underwent surgery within 7 days of admission, n = 28) and a delayed group (patients who underwent surgery at least 8 days after admission, n = 7). Comparisons were made between these groups.
RESULTS
RESULTS
No patients died. Significantly more patients required a conversion to open surgery (0% vs 28.5%, P = .003) or conversion to subtotal cholecystectomy (25.0% vs 71.4%, P = .020) in the delayed group than in the early group, and the total length of postoperative stay was significantly longer in the delayed group (11.4 vs 27.2 days, P = .001). The presence of negative predictive factors or risk factors listed in the 2018 Tokyo guidelines was not associated with death or postoperative complications.
CONCLUSIONS
CONCLUSIONS
Early surgery was considered appropriate and feasible for select patients who had Grade III AC and preoperative risk factors.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7-13Informations de copyright
© 2020 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.
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