Surgical Management of Acute Cholecystitis: Results of a 2-year Prospective Multicenter Survey in Belgium

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2012 Mar 13

PMID 22407152

Citations 29

Authors

Benoit Navez

Felicia Ungureanu

Martens Michiels

Donald Claeys

Filip Muysoms

Catherine Hubert

Marc Vanderveken

Olivier Detry

Bernard Detroz

Jean Closset

Bart Devos

Marc Kint

Julie Navez

Francis Zech

Jean-Francois Gigot

Affiliations

Soon will be listed here.

Abstract

Background: Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking.

Methods: A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients' clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis.

Results: Fifty-three surgeons consecutively and anonymously included 1,089 patients in this prospective study. A primary open approach was chosen in 74 patients (6.8%), whereas a laparoscopic approach was the first option in 1,015 patients (93.2%). Independent predictive factors for a primary open approach were previous history of upper abdominal surgery [odds ratio (OR) 4.13, p < 0.001], patient age greater than 70 years (OR 2.41, p < 0.05), surgeon with more than 10 years' experience (OR 2.08, p = 0.005), and gangrenous cholecystitis (OR 1.71, p < 0.05). In the laparoscopy group, 116 patients (11.4%) required conversion to laparotomy. Overall, 38 patients (3.5%) presented biliary complications and 49 had other local complications (4.5%). Incidence of bile duct injury was 1.2% in the whole series, 2.7% in the open group, and 1.1% in the laparoscopy group. Sixty patients had general complications (5.5%). The overall mortality rate was 0.8%. All patients who died were in poor general condition [American Society of Anesthesiologists (ASA) III or IV].

Conclusions: Although laparoscopic cholecystectomy is currently considered as the standard treatment for acute cholecystitis, an open approach is still a valid option in more advanced disease. However, overall mortality and incidence of bile duct injury remain high.

Citing Articles

LapBot-Safe Chole: validation of an artificial intelligence-powered mobile game app to teach safe cholecystectomy.

St John A, Khalid M, Masino C, Noroozi M, Alseidi A, Hashimoto D Surg Endosc. 2024; 38(9):5274-5284.

PMID: 39009730 DOI: 10.1007/s00464-024-11068-3.

Safety of laparoscopic cholecystectomy performed by trainee surgeons with different cholangiographic techniques (SCOTCH): a prospective non-randomized trial on the impact of fluorescent cholangiography during laparoscopic cholecystectomy performed....

Ortenzi M, Corallino D, Botteri E, Balla A, Arezzo A, Sartori A Surg Endosc. 2023; 38(2):1045-1058.

PMID: 38135732 DOI: 10.1007/s00464-023-10613-w.

Laparoscopic cholecystectomy for acute cholecystitis: Any time is a good time.

Wani H, Meher S, Srinivasulu U, Mohanty L, Modi M, Ibrarullah M Ann Hepatobiliary Pancreat Surg. 2023; 27(3):271-276.

PMID: 37088998 PMC: 10472128. DOI: 10.14701/ahbps.22-127.

An intraoperative artificial intelligence system identifying anatomical landmarks for laparoscopic cholecystectomy: a prospective clinical feasibility trial (J-SUMMIT-C-01).

Nakanuma H, Endo Y, Fujinaga A, Kawamura M, Kawasaki T, Masuda T Surg Endosc. 2022; 37(3):1933-1942.

PMID: 36261644 DOI: 10.1007/s00464-022-09678-w.

Learning curve for the surgical time of laparoscopic cholecystectomy performed by surgical trainees using the three-port method: how many cases are needed for stabilization?.

Komatsu M, Yokoyama N, Katada T, Sato D, Otani T, Harada R Surg Endosc. 2022; 37(2):1252-1261.

PMID: 36171452 DOI: 10.1007/s00464-022-09666-0.

References

Horiuchi A, Watanabe Y, Doi T, Sato K, Yukumi S, Yoshida M . Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions. Surg Endosc. 2008; 22(12):2720-3. DOI: 10.1007/s00464-008-9879-y. View

Brodsky A, Matter I, Sabo E, Cohen A, ABRAHAMSON J, Eldar S . Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc. 2000; 14(8):755-60. DOI: 10.1007/s004640000182. View

Yol S, Kartal A, Vatansev C, Aksoy F, Toy H . Sex as a factor in conversion from laparoscopic cholecystectomy to open surgery. JSLS. 2007; 10(3):359-63. PMC: 3015697. View

Hubert C, Annet L, Van Beers B, Gigot J . The "inside approach of the gallbladder" is an alternative to the classic Calot's triangle dissection for a safe operation in severe cholecystitis. Surg Endosc. 2010; 24(10):2626-32. DOI: 10.1007/s00464-010-0966-5. View

David G, Al-Sarira A, Willmott S, Deakin M, Corless D, Slavin J . Management of acute gallbladder disease in England. Br J Surg. 2007; 95(4):472-6. DOI: 10.1002/bjs.5984. View

Glavic Z, Begic L, Simlesa D, Rukavina A . Treatment of acute cholecystitis. A comparison of open vs laparoscopic cholecystectomy. Surg Endosc. 2001; 15(4):398-401. DOI: 10.1007/s004640000333. View

IHASZ M, Szeberin Z, Sandor J, Mate M . Biliary tract complications in laparoscopic cholecystectomy. A multicenter study of 148 biliary tract injuries in 26,440 operations. Surg Endosc. 1998; 12(4):294-300. DOI: 10.1007/s004649900657. View

Martin M, Abrams M, Arkin R, Ballen P, Blievernicht S, Bowman W . Safe laparoscopic cholecystectomy in a community setting, N = 762. Surg Endosc. 1993; 7(4):300-3. DOI: 10.1007/BF00725944. View

Lau H, Lo C, Patil N, Yuen W . Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc. 2005; 20(1):82-7. DOI: 10.1007/s00464-005-0100-2. View

10.

Fitzgibbons Jr R, Tseng A, Wang H, Ryberg A, Nguyen N, Sims K . Acute cholecystitis. Does the clinical diagnosis correlate with the pathological diagnosis?. Surg Endosc. 1996; 10(12):1180-4. DOI: 10.1007/s004649900274. View

11.

Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson B . Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2009; 97(2):141-50. DOI: 10.1002/bjs.6870. View

12.

Pessaux P, Tuech J, Rouge C, DUPLESSIS R, Cervi C, Arnaud J . Laparoscopic cholecystectomy in acute cholecystitis. A prospective comparative study in patients with acute vs. chronic cholecystitis. Surg Endosc. 2000; 14(4):358-61. DOI: 10.1007/s004640020088. View

13.

Tian Y, Wu S, Su Y, Kong J, Yu H, Fan Y . Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: experience of a hospital in northern China. Surg Today. 2009; 39(6):510-3. DOI: 10.1007/s00595-008-3916-2. View

14.

Suter M, Meyer A . A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe?. Surg Endosc. 2001; 15(10):1187-92. DOI: 10.1007/s004640090098. View

15.

Nakajima J, Sasaki A, Obuchi T, Baba S, Nitta H, Wakabayashi G . Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Today. 2009; 39(10):870-5. DOI: 10.1007/s00595-008-3975-4. View

16.

Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D . Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg. 2001; 25(10):1352-6. DOI: 10.1007/s00268-001-0122-4. View

17.

Kim J, Kim J, Jeong I, Choi T, Yoo B, Kim J . Surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis. J Gastrointest Surg. 2008; 12(5):829-35. DOI: 10.1007/s11605-008-0504-0. View

18.

Siddiqui T, MacDonald A, Chong P, Jenkins J . Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2007; 195(1):40-7. DOI: 10.1016/j.amjsurg.2007.03.004. View

19.

Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L . Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg. 2004; 92(1):44-9. DOI: 10.1002/bjs.4836. View

20.

Nuzzo G, Giuliante F, Giovannini I, Ardito F, DAcapito F, Vellone M . Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg. 2005; 140(10):986-92. DOI: 10.1001/archsurg.140.10.986. View