2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Pisano Michele, Allievi Niccolò, Gurusamy Kurinchi, Borzellino Giuseppe, Cimbanassi Stefania, Boerna Djamila, Coccolini Federico, Tufo Andrea, Di Martino Marcello, Leung Jeffrey, Sartelli Massimo, Ceresoli Marco, Maier Ronald V, Poiasina Elia, De Angelis Nicola, Magnone Stefano, Fugazzola Paola, Paolillo Ciro, Coimbra Raul, Di Saverio Salomone, De Simone Belinda, Weber Dieter G, Sakakushev Boris E, Lucianetti Alessandro, Kirkpatrick Andrew W, Fraga Gustavo P, Wani Imitaz, Biffl Walter L, Chiara Osvaldo, Abu-Zidan Fikri, Moore Ernest E, Leppäniemi Ari, Kluger Yoram, Catena Fausto, Ansaloni Luca
Аннотация
MATERIALS AND METHODS: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/ ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached.
RESULTS: The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal.
CONCLUSIONS, KNOWLEDGE GAPS AND RESEARCH RECOMMENDATIONS: ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.