Vinoban Amirthalingam1, Jee Keem Low2, Winston Woon2, Vishalkumar Shelat2. 1. Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore. vinoban.amirthalingam@mohh.com.sg. 2. Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore.
Abstract
OBJECTIVE: The aim of this study was to determine whether early laparoscopic cholecystectomy (LC) is safe and feasible for patients diagnosed with moderate (grade 2) and severe (grade 3) acute cholecystitis (AC) according to the Tokyo Guidelines 2013 (TG13). BACKGROUND: Early cholecystectomy is the current accepted standard of care for patients with mild (grade 1) and selected grade 2 AC based on TG13. For selected grade 2 and grade 3 AC, early percutaneous cholecystostomy (PC) followed by delayed cholecystectomy is recommended. METHODS: Patients diagnosed with AC over a 14-month period were identified and divided into three grades of AC based upon chart review using the grading and severity indicators according to TG13. RESULTS: A total of 149 patients underwent emergency LC. Eighty-two (55 %) patients were male. Eighty-four (56.4 %) patients were classified as grade 1 AC, 49 (32.9 %) as grade 2, and 16 (10.7 %) as grade 3. Eighty-three (98.8 %) patients with grade 1 AC underwent emergency LC, and 1 patient (1.2 %) underwent PC followed by emergency LC. The median length of hospital stay for grade 1 AC patients was 2 (1-11) days. There were 2 (2.4 %) readmissions with fever and no additional complications. Among the 65 patients identified with grade 2 or 3 AC, 6 (9.2 %) underwent PC followed by emergency LC. Fifty-nine (90.8 %) patients underwent emergency cholecystectomy: 58 (98.3 %) LC and one (1.7 %) open cholecystectomy. Among the 58 patients with LC, 3 (5.2 %) patients had open conversion and 10 (17.2 %) patients required subtotal cholecystectomy. One patient was converted to open due to bile duct injury and had hepaticojejunostomy repair. Two other patients were converted due to dense adhesions and inability to safely dissect Calot's triangle. The median length of hospital stay was 4 (1-28) days. There was one readmission for ileus. CONCLUSION: Severity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is warranted.
OBJECTIVE: The aim of this study was to determine whether early laparoscopic cholecystectomy (LC) is safe and feasible for patients diagnosed with moderate (grade 2) and severe (grade 3) acute cholecystitis (AC) according to the Tokyo Guidelines 2013 (TG13). BACKGROUND: Early cholecystectomy is the current accepted standard of care for patients with mild (grade 1) and selected grade 2 AC based on TG13. For selected grade 2 and grade 3 AC, early percutaneous cholecystostomy (PC) followed by delayed cholecystectomy is recommended. METHODS:Patients diagnosed with AC over a 14-month period were identified and divided into three grades of AC based upon chart review using the grading and severity indicators according to TG13. RESULTS: A total of 149 patients underwent emergency LC. Eighty-two (55 %) patients were male. Eighty-four (56.4 %) patients were classified as grade 1 AC, 49 (32.9 %) as grade 2, and 16 (10.7 %) as grade 3. Eighty-three (98.8 %) patients with grade 1 AC underwent emergency LC, and 1 patient (1.2 %) underwent PC followed by emergency LC. The median length of hospital stay for grade 1 AC patients was 2 (1-11) days. There were 2 (2.4 %) readmissions with fever and no additional complications. Among the 65 patients identified with grade 2 or 3 AC, 6 (9.2 %) underwent PC followed by emergency LC. Fifty-nine (90.8 %) patients underwent emergency cholecystectomy: 58 (98.3 %) LC and one (1.7 %) open cholecystectomy. Among the 58 patients with LC, 3 (5.2 %) patients had open conversion and 10 (17.2 %) patients required subtotal cholecystectomy. One patient was converted to open due to bile duct injury and had hepaticojejunostomy repair. Two other patients were converted due to dense adhesions and inability to safely dissect Calot's triangle. The median length of hospital stay was 4 (1-28) days. There was one readmission for ileus. CONCLUSION: Severity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is warranted.
Entities:
Keywords:
Acute cholecystitis; Body mass index; Delayed cholecystectomy; Early laparoscopic cholecystectomy; Gallbladder drainage; Percutaneous cholecystostomy; Subtotal cholecystectomy; Tokyo Guidelines
Authors: A Croo; E De Wolf; K Boterbergh; A Vanlander; H Peeters; R I Troisi; F Berrevoet Journal: Acta Gastroenterol Belg Date: 2014-09 Impact factor: 1.316
Authors: Yuichi Yamashita; Tadahiro Takada; Yoshifumi Kawarada; Yuji Nimura; Masahiko Hirota; Fumihiko Miura; Toshihiko Mayumi; Masahiro Yoshida; Steven Strasberg; Henry A Pitt; Eduardo de Santibanes; Jacques Belghiti; Markus W Büchler; Dirk J Gouma; Sheung-Tat Fan; Serafin C Hilvano; Joseph W Y Lau; Sun-Whe Kim; Giulio Belli; John A Windsor; Kui-Hin Liau; Vibul Sachakul Journal: J Hepatobiliary Pancreat Surg Date: 2007-01-30
Authors: Massimo Sartelli; Dieter G Weber; Etienne Ruppé; Matteo Bassetti; Brian J Wright; Luca Ansaloni; Fausto Catena; Federico Coccolini; Fikri M Abu-Zidan; Raul Coimbra; Ernest E Moore; Frederick A Moore; Ronald V Maier; Jan J De Waele; Andrew W Kirkpatrick; Ewen A Griffiths; Christian Eckmann; Adrian J Brink; John E Mazuski; Addison K May; Rob G Sawyer; Dominik Mertz; Philippe Montravers; Anand Kumar; Jason A Roberts; Jean-Louis Vincent; Richard R Watkins; Warren Lowman; Brad Spellberg; Iain J Abbott; Abdulrashid Kayode Adesunkanmi; Sara Al-Dahir; Majdi N Al-Hasan; Ferdinando Agresta; Asma A Althani; Shamshul Ansari; Rashid Ansumana; Goran Augustin; Miklosh Bala; Zsolt J Balogh; Oussama Baraket; Aneel Bhangu; Marcelo A Beltrán; Michael Bernhard; Walter L Biffl; Marja A Boermeester; Stephen M Brecher; Jill R Cherry-Bukowiec; Otmar R Buyne; Miguel A Cainzos; Kelly A Cairns; Adrian Camacho-Ortiz; Sujith J Chandy; Asri Che Jusoh; Alain Chichom-Mefire; Caroline Colijn; Francesco Corcione; Yunfeng Cui; Daniel Curcio; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Sameer Dhingra; José J Diaz; Isidoro Di Carlo; Angel Dillip; Salomone Di Saverio; Michael P Doyle; Gereltuya Dorj; Agron Dogjani; Hervé Dupont; Soumitra R Eachempati; Mushira Abdulaziz Enani; Valery N Egiev; Mutasim M Elmangory; Paula Ferrada; Joseph R Fitchett; Gustavo P Fraga; Nathalie Guessennd; Helen Giamarellou; Wagih Ghnnam; George Gkiokas; Staphanie R Goldberg; Carlos Augusto Gomes; Harumi Gomi; Manuel Guzmán-Blanco; Mainul Haque; Sonja Hansen; Andreas Hecker; Wolfgang R Heizmann; Torsten Herzog; Adrien Montcho Hodonou; Suk-Kyung Hong; Reinhold Kafka-Ritsch; Lewis J Kaplan; Garima Kapoor; Aleksandar Karamarkovic; Martin G Kees; Jakub Kenig; Ronald Kiguba; Peter K Kim; Yoram Kluger; Vladimir Khokha; Kaoru Koike; Kenneth Y Y Kok; Victory Kong; Matthew C Knox; Kenji Inaba; Arda Isik; Katia Iskandar; Rao R Ivatury; Maurizio Labbate; Francesco M Labricciosa; Pierre-François Laterre; Rifat Latifi; Jae Gil Lee; Young Ran Lee; Marc Leone; Ari Leppaniemi; Yousheng Li; Stephen Y Liang; Tonny Loho; Marc Maegele; Sydney Malama; Hany E Marei; Ignacio Martin-Loeches; Sanjay Marwah; Amos Massele; Michael McFarlane; Renato Bessa Melo; Ionut Negoi; David P Nicolau; Carl Erik Nord; Richard Ofori-Asenso; AbdelKarim H Omari; Carlos A Ordonez; Mouaqit Ouadii; Gerson Alves Pereira Júnior; Diego Piazza; Guntars Pupelis; Timothy Miles Rawson; Miran Rems; Sandro Rizoli; Claudio Rocha; Boris Sakakushev; Miguel Sanchez-Garcia; Norio Sato; Helmut A Segovia Lohse; Gabriele Sganga; Boonying Siribumrungwong; Vishal G Shelat; Kjetil Soreide; Rodolfo Soto; Peep Talving; Jonathan V Tilsed; Jean-Francois Timsit; Gabriel Trueba; Ngo Tat Trung; Jan Ulrych; Harry van Goor; Andras Vereczkei; Ravinder S Vohra; Imtiaz Wani; Waldemar Uhl; Yonghong Xiao; Kuo-Ching Yuan; Sanoop K Zachariah; Jean-Ralph Zahar; Tanya L Zakrison; Antonio Corcione; Rita M Melotti; Claudio Viscoli; Perluigi Viale Journal: World J Emerg Surg Date: 2016-07-15 Impact factor: 5.469
Authors: Ana María González-Castillo; Juan Sancho-Insenser; Maite De Miguel-Palacio; Josep-Ricard Morera-Casaponsa; Estela Membrilla-Fernández; María-José Pons-Fragero; Miguel Pera-Román; Luis Grande-Posa Journal: World J Emerg Surg Date: 2021-05-11 Impact factor: 5.469
Authors: Carlos Augusto Gomes; Cleber Soares Junior; Salomone Di Saverio; Massimo Sartelli; Michael Denis Kelly; Camila Couto Gomes; Felipe Couto Gomes; Lívia Dornellas Corrêa; Camila Brandão Alves; Samuel de Fádel Guimarães Journal: World J Gastrointest Surg Date: 2017-05-27