Top

Surgical Endoscopy

Published in:

01-04-2017

Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany

Authors: Stefan Jansen, Johannes Doerner, Susanne Macher-Heidrich, Hubert Zirngibl, Peter C. Ambe

Published in: Surgical Endoscopy | Issue 4/2017

Abstract

Background

Acute perforated cholecystitis (APC) is probably the most severe complication of acute cholecystitis. However, data on the outcome of cholecystectomy for APC are limited to small series. This study investigated the outcomes of cholecystectomy for APC.

Methods

Data from a prospectively maintained quality control database in Germany were analyzed. Cases with APC were compared to cases without gallbladder perforation with regard to demographic characteristics, clinical findings and surgical outcomes.

Results

A total of 5704 patients with APC were compared to 39,661 patients without perforation. Risk factors for APC included: the male gender, advanced age (>65 years), ASA score >2, elevated white blood count (WBC), positive findings on abdominal ultrasound sonography and fever. The APC group differed significantly from the control group with regard to fever (29.8 vs. 12.2 %), elevated WBC (83.8 vs. 65.4 %) and positive findings from ultrasound sonography (84.9 vs. 78.9 %), p < 0001. Preoperative computed tomography (CT) was ordered significantly more often in the APC group compared to the control group (2.3 vs. 1.0 %, p = 0.001). Surgery lasted significantly longer in the APC group (92.3 ± 40.8 vs. 73.7 ± 34.1, p < 0.001). The rates of conversion (18.9 vs. 6.8 %), bile duct injury (1.4 vs. 0.5 %), re-intervention (6.9 vs. 2.9 %) and mortality (4.3 vs. 1.3 %) were significantly higher in the APC group (p < 0.001). Similarly, the length of stay (13.4 ± 11.4 vs. 9.0 ± 8.3, p < 0.001) was significantly longer in the APC group.

Conclusion

Acute perforated cholecystitis is a severe complication of acute cholecystitis. Surgical dissection could be challenging with high risks of bile duct injury and conversion. The rates of morbidity and mortality are higher compared to those of patients without perforation.

Available only for authorised users

Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E (2006) Diagnosis and treatment of gallbladder perforation. World J Gastroenterol 12(48):7832–7836CrossRefPubMedPubMedCentral

Abu-Dalu J, Urca I (1971) Acute cholecystitis with perforation into the peritoneal cavity. Arch Surg 102(2):108–110CrossRefPubMed

Roslyn J, Busuttil RW (1979) Perforation of the gallbladder: a frequently mismanaged condition. Am J Surg 137(3):307–312CrossRefPubMed

Ambe P, Weber SA, Christ H, Wassenberg D (2014) Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25-72 hour”? A case control study. World J Emerg Surg 9(1):60CrossRefPubMedPubMedCentral

Aihara N, Yoshinaga K, Shoji Y, Kojima K, Nihei Z, Mishima Y (1997) Perforation of acalculous cholecystitis associated with localized atherosclerosis: report of a case. Surg Today 27(4):357–359CrossRefPubMed

Williams N, Scobie T (1976) Perforation of the gallbladder: analysis of 19 cases. Can Med Assoc J 115(12):1223PubMedPubMedCentral

Niemeier OW (1934) Acute free perforation of the gall-bladder. Ann Surg 99(6):922–924CrossRefPubMedPubMedCentral

Date RS, Thrumurthy SG, Whiteside S, Umer MA, Pursnani KG, Ward JB, Mughal MM (2012) Gallbladder perforation: case series and systematic review. Int J Surg 10(2):63–68CrossRefPubMed

Lennon F, Green WE (1983) Perforation of the gallbladder. A review of 32 cases. J R Coll Surg Edinb 28(3):169–173PubMed

10.

Ong CL, Wong TH, Rauff A (1991) Acute gall bladder perforation—a dilemma in early diagnosis. Gut 32(8):956–958CrossRefPubMedPubMedCentral

11.

Gurusamy KS, Davidson C, Gluud C, Davidson BR (2013) Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev 6:CD005440

12.

Gutt CN, Encke J, Koninger J, Harnoss JC, Weigand K, Kipfmuller K, Schunter O, Gotze T, Golling MT, Menges M et al (2013) Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg 258(3):385–393CrossRefPubMed

13.

Ambe PC, Jansen S, Macher-Heidrich S, Zirngibl H (2016) Surgical management of empyematous cholecystitis: a register study of over 12,000 cases from a regional quality control database in Germany. Surg Endosc. doi:10.1007/s00464-016-4882-1

14.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

15.

Essenhigh DM (1968) Perforation of the gall-bladder. Br J Surg 55(3):175–178CrossRefPubMed

16.

Pines B, Rabinovitch J (1954) Perforation of the gallbladder in acute cholecystitis. Ann Surg 140(2):170–179CrossRefPubMedPubMedCentral

17.

Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Buchler MW, Yokoe M et al (2013) TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 20(1):24–34CrossRefPubMed

18.

Stefanidis D, Sirinek KR, Bingener J (2006) Gallbladder perforation: risk factors and outcome. J Surg Res 131(2):204–208CrossRefPubMed

19.

Ambe PC, Papadakis M, Zirngibl H (2016) A proposal for a preoperative clinical scoring system for acute cholecystitis. J Surg Res 200(2):473–479CrossRefPubMed

20.

Ambe PC, Weber SA, Wassenberg D (2015) Is gallbladder inflammation more severe in male patients presenting with acute cholecystitis? BMC Surg 15:48CrossRefPubMedPubMedCentral

21.

Papadakis M, Ambe PC, Zirngibl H (2015) Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation. World J Emerg Surg 10:59CrossRefPubMedPubMedCentral

22.

Kim PN, Lee KS, Kim IY, Bae WK, Lee BH (1994) Gallbladder perforation: comparison of US findings with CT. Abdom Imaging 19(3):239–242CrossRefPubMed

23.

Miura F, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gouma DJ, Garden OJ, Buchler MW, Yoshida M, Mayumi T et al (2013) TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 20(1):47–54CrossRefPubMed

24.

Nikfarjam M, Shen L, Fink MA, Muralidharan V, Starkey G, Jones RM, Christophi C (2013) Percutaneous cholecystostomy for treatment of acute cholecystitis in the era of early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutaneous Tech 23(5):474–480CrossRef

25.

Ambe PC, Christ H, Wassenberg D (2015) Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis. BMC Gastroenterol 15:142CrossRefPubMedPubMedCentral

26.

Ambe PC, Zirngibl H (2015) The fate of patients managed with percutaneous cholecystostomy for acute cholecystitis. Surgery

27.

Gurusamy KS, Rossi M, Davidson BR (2013) Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 8:CD007088

Title: Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany
Authors: Stefan Jansen
Johannes Doerner
Susanne Macher-Heidrich
Hubert Zirngibl
Peter C. Ambe
Publication date: 01-04-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5190-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2017

Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach: vascular and nervous anatomy and technical steps to resection and lymphadenectomy

A new technique for minimally invasive irreversible electroporation of tumors in the head and body of the pancreas

Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study

Individualized airway-covered stent implantation therapy for thoracogastric airway fistula after esophagectomy

Is bariatric surgery safe in the elderly population?

Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection?