Lee HK, Han HS, Min SK, et al. Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis

Department of Surgery, Ewha Womans University, Sŏul, Seoul, South Korea
British Journal of Surgery (Impact Factor: 5.54). 04/2005; 92(4):463-6. DOI: 10.1002/bjs.4870
Source: PubMed


Complicated acute cholecystitis, for example when empyema or gangrene is present, is associated with increased postoperative morbidity and mortality rates. The aim of this study was to determine the correlation between sex, the severity of acute cholecystitis and the outcome of laparoscopic cholecystectomy.
Of 674 patients in whom laparoscopic cholecystectomy was attempted, 348 had chronic cholecystitis and 326 had acute cholecystitis. The medical records of the latter were reviewed retrospectively.
The proportion of male patients significantly increased with the severity of cholecystitis: 37.4 per cent of those with chronic cholecystitis were men, compared with 44.4 per cent of those with uncomplicated acute cholecystitis and 57 per cent of those with complicated acute cholecystitis (P = 0.001). Multivariate analysis showed that advanced age (odds ratio 2.24; P = 0.004) and male sex (odds ratio 1.76; P = 0.029) independently predicted complicated acute cholecystitis. The conversion rate to open operation was 6.4 per cent in men and 5.9 per cent in women (P = 0.843). The postoperative complication rate was 10.3 and 8.2 per cent respectively (P = 0.528).
Male sex was identified as a risk factor for more severe acute cholecystitis, but outcome for men after laparoscopic cholecystectomy was not significantly different from that for women.

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    • "However, there is still a high rate of open conversion and mortality in patients with high surgical risk, especially when emergency cholecystectomy is necessary.3,4 Nevertheless, we need to treat them definitely as early as possible, because 10 to 30 percent of patients with acute cholecystitis develop life threatening complications such as empyema, gangrene and perforation.5 "
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    ABSTRACT: Laparoscopic cholecystectomy is the best treatment choice for acute cholecystitis. However, it still carries high conversion and mortality rates. The purpose of this study was to find out better treatment strategies for high surgical risk patients with acute cholecystitis. Between January 2002 and June 2008, we performed percutaneous cholecystostomy instead of emergency cholecystectomy in 44 patients with acute cholecystitis and American Society of Anesthesiologists (ASA) classification 3 or greater. This was performed in 31 patients as a bridge procedure before elective cholecystectomy (bridge group) and as a palliative procedure in 11 patients (palliation group). The mean age of patients was 71.6 years (range 52-86 years). The mean ASA classifications before and after percutaneous cholecystostomy were 3.3 +/- 0.5 and 2.5 +/- 0.6, respectively, in the bridge group, and 3.6 +/- 0.7 and 3.1 +/- 1.0, in the palliation group, respectively. Percutaneous cholecystostomy was technically successful in all patients. There were two deaths after percutaneous cholecystostomy in the palliation group due to underlying ischemic heart disease and multiple organ failure. Resumption of oral intake was possible 2.9 +/- 1.8 days in the bridge group and 3.9 +/- 3.5 days in the palliation group after percutaneous cholecystostomy. We attempted 17 laparoscopic cholecystectomies and experienced one failure due to bile duct injury (success rate: 94.1%). The postoperative course of all cholecystectomy patients was uneventful. Percutaneous cholecystostomy is an effective bridge procedure before cholecystectomy in patients with acute cholecystitis and ASA classification 3 or greater.
    Yonsei medical journal 07/2010; 51(4):540-5. DOI:10.3349/ymj.2010.51.4.540 · 1.29 Impact Factor
    • "Elderly patients (≥60 years) are a risk group for late presentation, complicated gallstones, and comorbid disease.[182431] Several studies have documented increased rates of conversion, morbidity and mortality, and prolonged operation time and hospital stay after LC in the elderly.[810141618–22252631] In this series, the mean age of the patients was 39 years and 90% were below the age of 60 years, which excludes age as a risk factor. "
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    ABSTRACT: Previous studies regarding the outcome of laparoscopic cholecystectomy (LC) in men have reported inconsistent findings. We conducted this prospective study to test the hypothesis that the outcome of LC is worse in men than women. Between 1997 and 2002, a total of 391 consecutive LCs were performed by a single surgeon at King Fahd Hospital of the University. We collected and analyzed data including age, gender, body mass index (kg/m(2)), the American Society of Anesthesiologists (ASA) class, mode of admission (elective or emergency), indication for LC (chronic or acute cholecystitis [AC]), comorbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay. Bivariate analysis showed that both genders were matched for age, ASA class and mode of admission. The incidences of AC (P = 0.003) and comorbid disease (P = 0.031) were significantly higher in men. Women were significantly more obese than men (P < 0.001) and had a higher incidence of previous abdominal surgery (P = 0.017). There were no statistical differences between genders with regard to rates of conversion (P = 0.372) and complications (P = 0.647) and operation time (P = 0.063). The postoperative stay was significantly longer in men than women (P = 0.001). Logistic regression analysis showed that male gender was not an independent predictor of conversion (Odds ratio [OR] = 0.37 and P = 0.43) or complications (OR = 0.42, P = 0.42). Linear regression analysis showed that male gender was not an independent predictor of the operation time, but was associated with a longer postoperative stay (P = 0.02). Male gender is not an independent risk factor for satisfactory outcome of LC in the experience of a single surgeon.
    Saudi Journal of Gastroenterology 05/2008; 14(2):73-9. DOI:10.4103/1319-3767.39622 · 1.12 Impact Factor
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    ABSTRACT: Resumen La colecistectomía laparoscópica ha sido aceptada como el méto-do de elección para el tratamiento de las patologías quirúrgicas de la vesícula biliar. Sin embargo, a pesar de que es considerada como un procedimiento laparoscópico básico, en ocasiones debe conver-tirse a un procedimiento abierto. Pacientes y métodos: Se estudiaron 1,843 pacientes sometidos a colecistectomía laparoscópica del 1 de enero, 1999 al 31 de di-ciembre, 2003 en el Hospital ABC, utilizando el expediente médico electrónico. Resultados: Fueron 1,150 mujeres (62.39%) y 691 hombres (37.56%), con una edad promedio de 49 años. Cuatrocientos ochenta pacientes fueron intervenidos de urgencia (26.07%) y 1,361 de for-ma electiva (73.92%). Hubo 42 complicaciones (2.28%). Las más frecuentes fueron: sangrado del lecho vesicular y sangrado de al-gún puerto. Se convirtieron 51 casos (2.7%) y en sólo doce de ellos la causa fue una complicación (23.52%). En los 39 casos restantes la principal causa de conversión fue la presencia de adherencias e imposibilidad para identificar las estructuras anatómicas. La edad promedio en este grupo de pacientes fue de 58 años. Cuarenta casos fueron intervenidos de forma electiva (78.47%) y once pa-cientes de urgencia (21.56%). En ambas, la causa más frecuente de conversión fueron las adherencias y la imposibilidad para identi-ficar la anatomía. El tiempo de estancia intrahospitalaria promedio fue de 6 días. El tiempo quirúrgico promedio fue de 197 minutos. El índice de masa corporal en este grupo de pacientes fue de 26.72 kg/m 2 (13.39 a 42.27 kg/m 2). Cincuenta por ciento de este grupo de pacientes presentaban cole-cistitis aguda, el 30% colecistitis crónica y los restantes otras con-diciones como síndrome de Mirizzi, coledocolitiasis, etc. La única variable que se relaciona con un riesgo elevado de conversión es la edad (p = 0.01; OR = 1.30). Las diferencias de los días de estancia Abstract Laparoscopic cholecystectomy has been accepted as the treatment of choice for the surgical pathologies of the gallbladder. It is consid-ered a basic laparoscopic procedure, nevertheless it has to be con-verted to an open procedure occasionally. Patients and methods: We studied 1,841 patients who underwent laparoscopic cholecytstectomy at the ABC Medical Center, from January 1, 1999 to December 31, 2003. We used the Medical Elec-tronic File System. Results: There were 1,150 women (62.39%) and 691 men (37.56%) with a mean age of 49 years. Four hundred and eighty patients underwent emergency procedures (26.07%) and 1,316 were operated on electively (73.92%). There were 42 complica-tions (2.28%), the most frequent were hemorrhage of the gall-bladder bed and bleeding of a laparoscopic port. Fifty-one cas-es were converted to an open procedure (2.7%), only twelve of them due to a complication (23.52%). In the remaining 38 cases the conversion was due to the presence of adhesions and tech-nical difficulties. The mean age in this group was 58 years. For-ty patients underwent elective surgery (78.47%) and eleven un-derwent emergency procedures (21.56%). The mean hospital stay was 6 days for this group of patients and the average sur-gical time was 197 minutes. The body mass index in this group of patients was 26.72 kg/m 2 (13.39 a 42.27 kg/m 2). Fifty percent of these patients presented with acute cholecystitis, 30% chronic cholecystitis and the rest had associated conditions such as Mirizzi's syndrome, choledocholithiasis, etc. The only variable related to an elevated conversion risk was the age (p = 0.01; OR = 1.30). The difference between the in-hospital stay (2.2 vs 6 days) and the difference in the surgical time were also statis-tically significant (p = 0.003 [OR = 1.11] and p = 0.000 [OR = 1.01]), respectively.
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