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Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

Lo, C M; Liu, C L; Fan, S T; Lai, E C; Wong, J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1998 EN
Relevância na Pesquisa
26.84%
OBJECTIVE: A prospective randomized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates. It is not known whether there is a role for initial conservative treatment followed by interval elective operation. METHOD: During a 26-month period, 99 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n = 49) or delayed interval surgery after initial medical treatment (delayed group, n = 50). Thirteen patients (four in the early group and nine in the delayed group) were excluded because of refusal of operation (n = 6), misdiagnosis (n = 5), contraindication for surgery (n = 1), or loss to follow-up (n = 1). RESULTS: Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n = 3) and persistent fever (n = 5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs. 11%; p = 0.174) and complication rate (29% vs. 13%; p = 0.07). For 38 patients with symptoms exceeding 72 hours before admission...

Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.

Lo, C M; Liu, C L; Lai, E C; Fan, S T; Wong, J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/1996 EN
Relevância na Pesquisa
26.61%
OBJECTIVE: The current study compared the results of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. SUMMARY BACKGROUND DATA: Although recent reports have suggested the use of laparoscopic cholecystectomy for acute cholecystitis, the complication and conversion rates remain high. No data are available on whether initial medical treatment can improve the results. METHOD: Among 497 patients who underwent laparoscopic cholecystectomy, 52 (10.5%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. Twenty-seven of these patients had early surgery, that is, within 120 hours of admission, and 25 had interval cholecystectomy after initial medical treatment. RESULTS: The early group required modifications in operative technique more frequently (p < 0.001). The conversion rate (7.4%) and minor complication rate (22%) were comparable. Successful early laparoscopic cholecystectomy required a longer operative time (137.2 minutes vs. 98.0 minutes; p < 0.05) and postoperative hospital stay (4.6 days vs. 2.5 days; p < 0.005) but reduced the total hospital stay (6.4 days vs. 12.4 days; p < 0.001). CONCLUSIONS: Early laparoscopic cholecystectomy for the treatment of acute cholecystitis has no adverse effect on complication and conversion rates. Although it is technically demanding and time consuming...

Recovery of fasted and fed gastrointestinal motility after open versus laparoscopic cholecystectomy in dogs.

Hotokezaka, M; Combs, M J; Mentis, E P; Schirmer, B D
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1996 EN
Relevância na Pesquisa
26.66%
OBJECTIVE: The authors investigate the recovery of gastrointestinal motility in the fed and fasted state after laparoscopic and open cholecystectomy. SUMMARY BACKGROUND DATA: Clinical recovery after laparoscopic cholecystectomy is known to be more rapid than after conventional open cholecystectomy. However, the actual effect of a laparoscopic approach on gastrointestinal motility, particularly fed-state motility, is not well investigated. METHODS: Laparoscopic (LAP, n=6) or open (OPEN, n=6) cholecystectomy was performed in 12 dogs. Bipolar recording electrodes were placed on the antrum, small intestine, and the transverse and descending colon, and fasting myoelectric data were recorded after operation. Solid meal gastric emptying studies were performed before surgery and on postoperative days 1 and 2. Transit time studies were performed using 10 radiopaque markers. RESULTS: Gastric emptying was significantly delayed in the OPEN group at 120 minutes on postoperative day 1 compared with pre-operative emptying (p<0.05), but was not delayed on postoperative day 2. Gastric emptying was not delayed in the LAP group after operation. Transit time was the same between groups. Gastric dysrhythmias were more frequent on postoperative day 3 (p<0.05) in the OPEN group. There were no significant differences in the presence...

Appropriate Timing of Cholecystectomy in Patients Who Present With Moderate to Severe Gallstone-Associated Acute Pancreatitis With Peripancreatic Fluid Collections

Nealon, William H.; Bawduniak, John; Walser, Eric M.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2004 EN
Relevância na Pesquisa
36.44%
Comparison of early operation versus monitoring with delayed cholecystectomy in 187 patients with moderate to severe gallstone-associated acute pancreatitis and subsequent peripancreatic fluid collections with pseudocyst formation. Results suggest that cholecystectomy be delayed until pseudocysts resolve or persist beyond 6 weeks.

Laparoscopic cholecystectomy. Experience with 375 consecutive patients.

Bailey, R W; Zucker, K A; Flowers, J L; Scovill, W A; Graham, S M; Imbembo, A L
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1991 EN
Relevância na Pesquisa
26.47%
Three hundred seventy-five consecutive patients underwent laparoscopic cholecystectomy from September 1989 to January 1991. Three hundred forty-one (91%) presented on an elective basis, and the remaining 34 patients (9%) were admitted for acute cholecystitis (24), gallstone pancreatitis (9), and cholangitis (1). Of the 375 patients, 20 were converted to laparotomy and cholecystectomy, for an overall success rate of 95% for patients undergoing laparoscopic cholecystectomy. Three hundred nineteen patients (90%) were discharged within 24 hours of surgery. Operative cholangiography was completed in 141 patients, showing choledocholithiasis in five (managed by postoperative endoscopic retrograde cholangiopancreatography [ERCP] in 4, common bile duct exploration [CBDE] in 1). Two retained stones (0.9%) were detected in 214 patients not undergoing cholangiography. Three patients (0.8%) were reoperated on because of perioperative complications. Overall morbidity for patients undergoing laparoscopic cholecystectomy was 3.5%. Major complications (0.6%) included a single common hepatic duct injury and a delayed cystic duct leak at 10 days. Minor complications occurred in 11 patients (2.9%). The single perioperative death (0.3%) was due to a myocardial infarction on postoperative day 3...

Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group.

Fullarton, G M; Bell, G
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1994 EN
Relevância na Pesquisa
26.56%
Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear. A prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland over a two year period was carried out to attempt to assess this new procedure. A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy submitted prospective data from September 1990-1992. A total of 2285 cholecystectomies were audited (a completed data collection rate of 99%). Laparoscopic cholecystectomy was attempted in 1683 (74%) patients and completed in 1448 patients (median conversion rate to the open procedure 17%). The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes (range 30-330) and overall hospital stay three days (1-33). There were nine deaths (0.5%) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure. In the laparoscopic cholecystectomy group there were 99 complications (5.9%), 53 (3%) of these were major requiring further invasive intervention. Forty patients (2.4%) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries. There were 11 (0.7%) bile duct injuries in the laparoscopic cholecystectomy series...

Asymptomatic Cholelithiasis in Children With Sickle Cell Disease: Early or Delayed Cholecystectomy?

Currò, Giuseppe; Meo, Anna; Ippolito, Daniela; Pusiol, Anna; Cucinotta, Eugenio
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/2007 EN
Relevância na Pesquisa
36.18%
Sickle cell disease (SCD) is the most important cause of cholelithiasis in children. Laparoscopic cholecystectomy (LC) is the standard treatment in symptomatic children, but it is still a source of debate as to what to do in children with clinically asymptomatic disease. A retrospective study was conducted to evaluate the role of elective LC in children with SCD and asymptomatic pigment gallstones.

Delayed cholecystectomy for gallstone pancreatitis: re-admissions and outcomes.

Cameron, Donald R.; Goodman, Anthony J.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/2004 EN
Relevância na Pesquisa
46.5%
OBJECTIVE: Timing of cholecystectomy after gallstone pancreatitis and use of pre-operative cholangiography varies considerably between surgeons. We examined outcomes in a district general hospital where most patients underwent delayed cholecystectomy following pre-operative cholangiography. METHODS: A retrospective review of admissions with gallstone pancreatitis over a 5-year period was conducted. RESULTS: A total of 77 patients with gallstone pancreatitis were identified of whom 58 underwent laparoscopic cholecystectomy (LC) at a median of 67.5 days after index admission. Of these patients, 21% had unplanned re-admission while awaiting LC rising to 25% of those who waited for more than 4 weeks. Surgery at 4 weeks would have been associated with a 6% re-admission rate. Re-admissions were due to pancreatitis (4 cases), cholecystitis (3 cases), biliary colic (4 cases) and pseudocyst (1 case). In all, 49 patients had pre-operative cholangiography and 13 had pre-operative endoscopic extraction of stones from the common bile duct. CONCLUSIONS: Delay of LC for greater than 4 weeks after gallstone pancreatitis is associated with a high, unplanned re-admission rate, even with liberal use of pre-operative cholangiography.

Timing of intervention in acute pancreatitis.

Johnson, C. D.
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em /07/1993 EN
Relevância na Pesquisa
26.44%
This review examines the appropriate timing of intervention in acute pancreatitis. In gallstone pancreatitis, it is now clear that cholecystectomy during the primary admission carries no greater risk of complications than delayed cholecystectomy and enables earlier recovery to normal activity. This course of action pre-empts a second, possibly fatal attack of acute pancreatitis. Cholecystectomy should be done after the acute phase has settled, before discharge from hospital. Patients with gallstones should now be offered endoscopic sphincterotomy within 48 hours of admission. This approach is safe, and reduces the risk of complications. When complications develop, early necrosectomy is only indicated if conservative measures fail. Delayed (> 10 days) necrosectomy is appropriate if there is evidence of sepsis, or clinical failure to improve. Pancreatic pseudocysts can often be managed expectantly; a high proportion will resolve spontaneously. After a delay of 12 weeks, persistent cysts require evaluation by endoscopic pancreatography, which gives crucial information in the choice between percutaneous or surgical drainage of the pseudocyst. A patient with pancreatitis is usually treated under the care of a surgeon, who has traditionally taken the decision on the timing of any intervention...

Acute cholecystitis--room for improvement?

Cameron, I. C.; Chadwick, C.; Phillips, J.; Johnson, A. G.
Fonte: Royal College of Surgeons of England Publicador: Royal College of Surgeons of England
Tipo: Artigo de Revista Científica
Publicado em /01/2002 EN
Relevância na Pesquisa
26.55%
AIMS: A recent survey of UK general surgeons showed that almost 90% prefer to manage patients with acute cholecystitis by initial conservative management and delayed cholecystectomy (DC). The aim of this study was to assess the effectiveness of this management policy in a large university hospital. PATIENTS AND METHODS: All patients admitted with acute cholecystitis between January 1997 and June 1999 who went on to have a cholecystectomy were identified. Patients were required to have right upper quadrant pain for > 12 h, a raised white cell count and findings consistent with acute cholecystitis on ultrasound to be included in the study. RESULTS: 109 patients were admitted with acute cholecystitis (76 female, 33 male) with a median age of 62 years (range, 22-88 years). Conservative management failed in 16 patients (14.7%) who underwent emergency cholecystectomy due to continuing symptoms (9), empyema (4) and peritonitis (3). Symptoms settled in 93 patients and delayed cholecystectomy was performed without further problems in 66 (60.6%). 27 patients were re-admitted with further symptoms before their elective surgery and, of these, 3 were admitted for a third time before surgical intervention. Ten of the 30 re-admission episodes (33%) occurred within 3 weeks of discharge but 15 (56%) occurred more than 2 months after discharge. Elective surgery was undertaken at a median of 10 weeks post-discharge with 67% of operations occurring within 3 months. Mean total hospital stay (days) +/- SEM...

Painless Obstructive Jaundice Secondary to a Common Bile Duct Abscess: A Delayed Sequela of Cholecystectomy

Fairhurst, Katherine; Strickland, Andrew; Bridgewater, Franklin H. G.; Maddern, Guy J.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.5%
Complications related to cholecystectomy are well described. Most occur in the early postoperative period and are recognised either at the time of, or shortly after surgery. Clinical sequelae occurring years following cholecystectomy are rare and infrequently reported. In addition, most delayed complications are related to the continuing presence or new formation of gallstones. In this paper we present a unique case of an abscess of the common bile duct wall, presenting with painless obstructive jaundice more than 30 years following an open cholecystectomy, without the presence of gallstones. The clinical presentation, investigations, and treatment are discussed with a review of other relevant reported cases in the literature.

Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study

Özkardeş, Alper Bilal; Tokaç, Mehmet; Dumlu, Ersin Gürkan; Bozkurt, Birkan; Çiftçi, Ahmet Burak; Yetişir, Fahri; Kılıç, Mehmet
Fonte: The International College of Surgeons, World Federation of General Surgeons and Surgical Specialists, Inc. Publicador: The International College of Surgeons, World Federation of General Surgeons and Surgical Specialists, Inc.
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
26.83%
We aimed to compare the clinical outcome and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Sixty patients with acute cholecystitis were randomized into early (within 24 hours of admission) or delayed (after 6–8 weeks of conservative treatment) laparoscopic cholecystectomy groups. There was no significant difference between study groups in terms of operation time and rates for conversion to open cholecystectomy. On the other hand, total hospital stay was longer (5.2 ± 1.40 versus 7.8 ± 1.65 days; P = 0.04) and total costs were higher (2500.97 ± 755.265 versus 3713.47 ± 517.331 Turkish Lira; P = 0.03) in the delayed laparoscopic cholecystectomy group. Intraoperative and postoperative complications were recorded in 8 patients in the early laparoscopic cholecystectomy group, whereas no complications occurred in the delayed laparoscopic cholecystectomy group (P = 0.002). Despite intraoperative and postoperative complications being associated more with early laparoscopic cholecystectomy compared with delayed intervention, early laparoscopic cholecystectomy should be preferred for treatment of acute cholecystitis because of its advantages of shorter hospital stay and lower cost.

Combined laparoscopic cholecystectomy with ileostomy reversal: A method of delayed definitive management of postoperative gallstone pancreatitis

Kulkarni, Gaurav V.; Sarker, Sharfi; Eberhardt, Joshua M.
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
26.44%
Traditional management of gallstone pancreatitis (GP) has been to perform cholecystectomy during the same hospital admission after resolution. However, when GP develops in the immediate postoperative period from a major colorectal operation, cholecystectomy may be fraught with difficulty due to the inflammatory response that occurs. Thus, delaying cholecystectomy until the inflammatory response subsides may be worthwhile, and it maximizes the chances of completing the cholecystectomy laparoscopically. We have described our management of 2 patients with GP occurring after colorectal operations, which required proximal diverting ileostomy. In both cases, we deferred management of GP with either endoscopic retrograde cholangiopancreatography (ERCP) or medical conservative measures during the acute attack and performed laparoscopic cholecystectomy during ostomy reversal surgery utilizing the existing ostomy takedown site for port placement. Both patients tolerated this management well.

Comparison of Clinical Safety and Outcomes of Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis

Zhou, Min-Wei; Gu, Xiao-Dong; Xiang, Jian-Bin; Chen, Zong-You
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.71%
Objective. To compare the clinical safety and outcomes of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for acute cholecystitis. Methods. Pertinent studies were selected from the Medline, EMBASE, and Cochrane library databases, references from published articles, and reviews. Seven randomized controlled trials (early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy) were selected. Conventional meta-analysis according to Cochrane Collaboration was used for the pooling of the results. Results. Seven trials with 1106 patients were included. There was no significant difference between the two groups in terms of bile duct injury (Peto odds ratio 0.49 (95% confidence interval 0.05 to 4.72); P = 0.54) or conversion to open cholecystectomy (risk ratio 0.91 (95% confidence interval 0.69 to 1.20); P = 0.50). The total hospital stay was shorter by 4 days for early laparoscopic cholecystectomy (mean difference −4.12 (95% confidence interval −5.22 to −3.03) days; P < 0.00001). Conclusion. Early laparoscopic cholecystectomy during acute cholecystitis is safe and shortens the total hospital stay.

Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

Agrawal, Rati; Sood, K. C.; Agarwal, Bhupender
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.53%
Background. The role of early laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis is not yet established. The aim of our prospective randomized study was to evaluate the safety and feasibility of early LC for acute cholecystitis and to compare the results with delayed LC. Methods. Between March 2007 to December 2008, 50 patients with diagnosis of acute cholecystitis were assigned randomly to early group, n = 25 (LC within 24 hrs of admission), and delayed group, n = 25 (initial conservative treatment followed by delayed LC, 6–8 weeks later). Results. We found in our study that the conversion rate in early LC and delayed LC was 16% and 8%, respectively, Operation time for early LC was 69.4 min versus 66.4 min for delayed LC, postoperative complications for early LC were 24% versus 8% for delayed LC, and blood loss was 159.6 mL early group versus 146.8 mL for delayed group. However early LC had significantly shorter hospital stay (4.1 days versus 8.6 days). Conclusions. Early LC for acute cholecystitis with cholelithiasis is safe and feasible, offering the additional benefit of shorter hospital stay. It should be offered to the patients with acute cholecystitis, provided that the surgery is performed within 96 hrs of acute symptoms by an experienced surgeon.

Painless obstructive jaundice secondary to a common bile duct abscess: A delayed sequela of cholecystectomy

Fairhurst, K.; Strickland, A.; Bridgewater, F.; Maddern, G.
Fonte: Hindawi Publishing Corp. Publicador: Hindawi Publishing Corp.
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
26.5%
Complications related to cholecystectomy are well described. Most occur in the early postoperative period and are recognised either at the time of, or shortly after surgery. Clinical sequelae occurring years following cholecystectomy are rare and infrequently reported. In addition, most delayed complications are related to the continuing presence or new formation of gallstones. In this paper we present a unique case of an abscess of the common bile duct wall, presenting with painless obstructive jaundice more than 30 years following an open cholecystectomy, without the presence of gallstones. The clinical presentation, investigations, and treatment are discussed with a review of other relevant reported cases in the literature.; Katherine Fairhurst, Andrew Strickland, Franklin H. G. Bridgewater, and Guy J. Maddern; Extent: 3p.

Evaluación de la colecistectomía temprana frente a la colecistectomía diferida como tratamiento de la colecistitis aguda; Evaluation of early cholecystectomy versus delayed cholecystectomy in the treatment of acute cholecystitis

Sánchez Carrasco, Miguel
Fonte: Universidade de Cantabria Publicador: Universidade de Cantabria
Tipo: Tese de Doutorado
SPA
Relevância na Pesquisa
66.72%
RESUMEN: El tratamiento de la colecistitis aguda contempla dos posibles alternativas quirúrgicas: colecistectomía temprana y colecistectomía diferida. La hipótesis de trabajo es que la colecistectomía temprana es segura en términos de morbi-mortalidad y puede aportar beneficios como menor estancia hospitalaria y menos reingresos. Se ha realizado un estudio retrospectivo comparando ambas opciones de tratamiento. Se analizan: el porcentaje de conversión, el tiempo quirúrgico, la morbilidad global, la morbilidad quirúrgica, la mortalidad, las reintervenciones, los días de estancia en cuidados intensivos, los reingresos hospitalarios, los días de ingreso hospitalario y los costes directos. En cirugía temprana se encuentra: menor morbilidad, a expensas de una menor tasa de infecciones y porcentajes de sangrado y lesión iatrogénica de la vía biliar similares, menor número de reingresos, menos estancias en cuidados intensivos y menos días de estancia hospitalaria. Además la cirugía temprana podría suponer un ahorro en costes directos.; ABSTRACT: Treatment of acute cholecystitis includes two possible surgical alternatives: early cholecystectomy and delayed cholecystectomy. The working hypothesis is that early cholecystectomy is safe in terms of morbidity and mortality and may provide benefits such as a shorter hospital stay and fewer readmissions. We performed a retrospective study comparing the two treatment options and analyzed: conversion risk...

Resultados del tratamiento de la colecistitis aguda en pacientes ancianos : comparación de diversas opciones terapeúticas: colecistectomía urgente, diferida, colecistostomía percutánea y tratamiento antibiótico; Results of acute cholecystitis treatment in elderly patients : comparison of different treatment options: urgent and delayed cholecystectomy, percutaneous cholecystostomy and antibiotic therapy

Calleja Arribas, Beatriz
Fonte: Universidade de Cantabria Publicador: Universidade de Cantabria
Tipo: Trabalho de Conclusão de Curso
SPA
Relevância na Pesquisa
36.18%
Introducción: los pacientes añosos asocian elevada comorbilidad por lo que en caso de colecistitis aguda (CA) se emplean alternativas a la colecistectomía como antibioterapia y colecistostomía percutánea (CPC), aunque se desconocen sus resultados a largo plazo. Objetivos: Analizar resultados a corto plazo en términos de morbilidad, mortalidad y resolución o progresión del proceso inflamatorio de los distintos tratamientos y los resultados a largo plazo en términos de eventos biliares.; Grado en Medicina

Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

Saber, Aly; Hokkam, Emad N.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.71%
Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A) and delayed (B) cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient's satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient's satisfaction was 92.66 ± 6.8 in group A compared with 75.34 ± 12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques.

Early Cholecystectomy for Acute Cholecystitis: A Prospective Randomized Study

Järvinen, Heikki J.; Hästbacka, Junno
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1980 EN
Relevância na Pesquisa
36.5%
A randomized clinical trial was undertaken to compare early and delayed cholecystectomy for acute cholecystitis. Patients entering early (n = 83) or delayed (n = 82) surgery groups were comparable with regard to prerandomization data. One patient in the early group and five in the delayed group refused surgery (p < 0.1) and two misdiagnoses occurred in each group. (2.4%). There was no difference in the incidence of technical difficulty measured by operative complications and duration of operations between the two groups. The same number of patients with common duct stones and perforations of the gallbladder were in each group. There was one death in the delayed group and none in the early group. Postoperative morbidity was 13.8% in the early group and 17.3% in the delayed surgery group (p > 0.1). Wound complications were slightly more common in the early surgery group (p > 0.1). In the delayed surgery group 13% of the patients had to be operated on before the planned date of surgery because conservative management failed. In addition, 15% of the patients had clear recurrent symptoms. Early surgery reduced total hospital stay by a mean of 7.5 days and the period of the patient's incapacity for work by 14.4 days. The data suggest that in acute cholecystitis early surgery is preferable when performed by an experienced surgeon with adequate pre- and intraoperative aids. Besides lower costs it offers the advantage of avoiding recurrent attacks and emergency operations without increasing mortality or morbidity.