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Войти в исследования La Tunisie medicale · 2016
Early versus delayed laparoscopic cholecystectomy for lithiasic acute cholecystitis during emergency admissions. Results of a monocentric experience and review of the literature.
Сравнительное исследованиеСтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
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Jarrar Mohamed Salah, Chouchène Ibrahim, Fadhl Houssem, Ghrissi Rafik, Elghali Amine, Ferhi Fehmi, Mraidha Hedi, Hamila Fehmi, Letaief Rached
Аннотация
BACKGROUND: It is established that the standard treatment for lithiasic acute cholecystitis is the laparoscopic cholecystectomie. However, the question of the timing of cholecystectomy remains controversial.
AIM: To compare early laparoscopic cholecystectomies (within 72 hours of symptom onset) and delayed laparoscopic cholecystectomies (beyond 72 hours) for lithiasic acute cholecystitis in terms of intra-operative difficulties and post-operative complications.
METHODS: The patients operated on for acute cholecystitis, between January 2007 and December 2012, were included in a retrospective study. They were divided into two groups based on whether surgery was performed before (group A) or after (group B) 72 hours after the onset of symptoms. We conducted a comparison between the two groups.
RESULTS: The two groups were comparable in terms of background, clinico-biological presentation, and radiological findings. The average time of surgery was 111.6 hours after symptom onset. Duration of surgery was significantly longer for group B (97 minutes versus 82.17 minutes, p = 0.003). There was more conversion in group B than in group A, without significant difference (20% versus 11.6%, p = 0.14). There were no deaths in our series. Specific post-operative complications were comparable between the two groups (wound infection: 3 (B) versus 1 (A), biliary fistula: 8 (B) versus 0 (A), p = Non significant). The post-operative hospital stay was significantly longer in group B (3.34 days versus 1.84, p <10-3).
CONCLUSION: In case of early laparoscopic cholecystectomy, the conversion rate and post-operative morbidity are comparable to the delayed treatment of acute cholecystitis. But the early surgery can reduce the cost of care, the duration of surgery and the hospital stay. Key-words : Lithiasic acute cholecystitis ; Laparoscopic cholecystectomy.
AIM: To compare early laparoscopic cholecystectomies (within 72 hours of symptom onset) and delayed laparoscopic cholecystectomies (beyond 72 hours) for lithiasic acute cholecystitis in terms of intra-operative difficulties and post-operative complications.
METHODS: The patients operated on for acute cholecystitis, between January 2007 and December 2012, were included in a retrospective study. They were divided into two groups based on whether surgery was performed before (group A) or after (group B) 72 hours after the onset of symptoms. We conducted a comparison between the two groups.
RESULTS: The two groups were comparable in terms of background, clinico-biological presentation, and radiological findings. The average time of surgery was 111.6 hours after symptom onset. Duration of surgery was significantly longer for group B (97 minutes versus 82.17 minutes, p = 0.003). There was more conversion in group B than in group A, without significant difference (20% versus 11.6%, p = 0.14). There were no deaths in our series. Specific post-operative complications were comparable between the two groups (wound infection: 3 (B) versus 1 (A), biliary fistula: 8 (B) versus 0 (A), p = Non significant). The post-operative hospital stay was significantly longer in group B (3.34 days versus 1.84, p <10-3).
CONCLUSION: In case of early laparoscopic cholecystectomy, the conversion rate and post-operative morbidity are comparable to the delayed treatment of acute cholecystitis. But the early surgery can reduce the cost of care, the duration of surgery and the hospital stay. Key-words : Lithiasic acute cholecystitis ; Laparoscopic cholecystectomy.