Hepato-gastroenterology · 2012
Laparoscopic cholecystectomy techniques with special care treatment in acute cholecystitis patients regardless of operation timing.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Meng Fan-Yun, Tsao Ming-Zheng, Huang Meng-Lin, Huang Hurng-Wern
Аннотация
BACKGROUND/AIMS: The optimal timing for laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) remains controversial. In this study, we aggressively performed three types of LC techniques in AC patients at different time with our care procedure.
METHODOLOGY: Forty-three patients with AC were retrospectively divided into two groups: Group one (n=16, within 72 hrs at the onset of symptoms) and Group two (n=27, beyond 72 hrs after the onset of symptoms). Standard, subtotal or prograde cholecystectomy were performed for all cases, depending on the fragility of gallbladder wall, difficulty of gallbladder dissection, assurance of Calot's triangle and quality of retraction over Hartman pouch.
RESULTS: There were no statistical differences between both groups with regards to age, operation time, length of hospital stay and complications. Gangrenous cholecystitis was found in 6.3% of cases in Group one and 26.9% in Group two, although not statistically different. Four cases (two in each of groups) underwent prograde cholecystectomy and four cases in the group 2 received subtotal cholecystectomy; all with longer operation time and length of stay, as compared to standard cholecystectomy. None of the 43 patients was converted to open procedure. Complications in this study were minor.
CONCLUSIONS: LC can be safely performed in patients with AC with special care, regardless of the duration between the onset of symptoms and operation. In addition to standard procedures, subtotal and prograde cholecystectomy could help to manage inflammatory gallbladder and obscured Calot's triangle.
METHODOLOGY: Forty-three patients with AC were retrospectively divided into two groups: Group one (n=16, within 72 hrs at the onset of symptoms) and Group two (n=27, beyond 72 hrs after the onset of symptoms). Standard, subtotal or prograde cholecystectomy were performed for all cases, depending on the fragility of gallbladder wall, difficulty of gallbladder dissection, assurance of Calot's triangle and quality of retraction over Hartman pouch.
RESULTS: There were no statistical differences between both groups with regards to age, operation time, length of hospital stay and complications. Gangrenous cholecystitis was found in 6.3% of cases in Group one and 26.9% in Group two, although not statistically different. Four cases (two in each of groups) underwent prograde cholecystectomy and four cases in the group 2 received subtotal cholecystectomy; all with longer operation time and length of stay, as compared to standard cholecystectomy. None of the 43 patients was converted to open procedure. Complications in this study were minor.
CONCLUSIONS: LC can be safely performed in patients with AC with special care, regardless of the duration between the onset of symptoms and operation. In addition to standard procedures, subtotal and prograde cholecystectomy could help to manage inflammatory gallbladder and obscured Calot's triangle.