Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis
ABSTRACT 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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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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ABSTRACT: Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out. A Medline, PubMed, Cochrane search. Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is 'therapeutic splitting' with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay. The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.Digestive Diseases 02/2005; 23(2):119-26. DOI:10.1159/000088593 · 1.83 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the safety of a laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in patients older than sixty years of age, with stratification based on the ASA (American Society of Anesthesiologists) score. For five years, 137 patients older than sixty, who had undergone a LC for AC, were classified into three groups; ASA 1 (n = 33), ASA 2 (n = 79) and ASA 3 (n = 25). Preoperative percutaneous gallbladder drainage was performed in eight of the 137 cases (5.8%). All except one underwent one-stage management and 19.7% patients underwent emergency surgery within 24 hours of the index admission of AC. The preoperative hospital stay for ASA 3 (8.8 days) was longer than that for ASA 1 (5.6 days). There was a higher proportion of complicated cholecystitis and a longer operating time in ASA 2 (50.6%, 111 min.) and 3 (66.7 %, 114 min.) than in ASA 1 (24.2%, 85 min.) (p<0.05). Morbidity was more frequent in ASA 3 (20.0%) than in ASA 1 (9.1%). However, the open conversion rate, time to diet, and postoperative hospital stay were similar in the three groups (p>0.05). We conclude that a LC for AC may be an effective treatment option in elderly-high risk patients.Minimally Invasive Therapy & Allied Technologies 01/2006; 15(3):159-64. DOI:10.1080/13645700600760044 · 1.18 Impact Factor