Erschienen in:
19.11.2020 | Original Article
Laparoscopic cholecystectomy for acute cholecystitis: is the surgery still safe beyond the 7-day barrier? A multicentric observational study
verfasst von:
Marcello Di Martino, Ismael Mora-Guzmán, Víctor Vaello Jodra, Alfonso Sanjuanbenito Dehesa, Dieter Morales-García, Rubén Caiña Ruiz, Francisca García-Moreno Nisa, Fernando Mendoza-Moreno, Sara Alonso Batanero, José Edecio Quiñones Sampedro, Paola Lora Cumplido, Altea Arango Bravo, Ines Rubio-Perez, Luis Asensio-Gomez, Fernando Pardo Aranda, Sara Sentí i Farrarons, Cristina Ruiz Moreno, Clara Maria Martinez Moreno, Aingeru Sarriugarte Lasarte, Mikel Prieto Calvo, Daniel Aparicio-Sánchez, Eduardo Perea del Pozo, Elena Martin-Perez
Erschienen in:
Updates in Surgery
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Ausgabe 1/2021
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Abstract
Timing for early laparoscopic cholecystectomy (ELC) in patients with acute calculous cholecystitis (ACC) is still controversial. This study assesses ELC for ACC with delayed presentation, according to hospital volume. Multicentric retrospective analysis of 1868 ELC. Patients were classified into two groups according to the timing of surgery from clinical onset and centre volume. Group 1 (G1) within the first 7 days, group 2 (G2) beyond that. Then centres were classified in low volume centres (LVC) and higher volume centres (HVC) according to the number of ELC performed per year. Overall, G2 showed increased conversion rate (17.7% vs 10.7%; p = 0.004), intraoperative complications (7.3% vs 2.9%; p = 0.001); postoperative haemorrhage (3.6% vs 0.8%; p < 0.001), infections (16.6% vs 9.3%; p = 0.003) and global complications (27.6% vs 19.8%; p = 0.011). HVC in comparison with LVC presented decreased conversion rate (17.1% vs 7.6%; p < 0.001), intraoperative bleeding (2.1% vs 1%; p = 0.047), postoperative bile leakage (4.1% vs 2.1%; p = 0.011), infectious (13.7% vs 7.5%; p < 0.001) and global complications (25.7% vs 17.1%; p < 0.001). HVC did not show an increase in any of the above-mentioned outcomes when G1 and G2 were compared. ELC must be indicated cautiously in patients with ACC and more than 1 week of symptom duration. It should be performed in centres with sufficient experience in the management of this disease.