Top

Surgical Endoscopy

Published in:

01-12-2016

Surgical management of empyematous cholecystitis: a register study of over 12,000 cases from a regional quality control database in Germany

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

Published in: Surgical Endoscopy | Issue 12/2016

Abstract

Background

Acute cholecystitis is a common indication for surgery. Surgical outcomes depend among other factors on the extent of gallbladder inflammation. Data on the outcomes of patients undergoing cholecystectomy due to acute empyematous cholecystitis are rare.

Methods

Data from a prospectively maintained quality control database in Germany were analyzed. Cases with empyematous cholecystitis were compared to cases without gallbladder empyema with regard to baseline features, clinical parameters and surgical outcomes.

Results

A total of 12,069 patients with empyematous cholecystitis (EC) were compared to 33,296 patients without empyema. The male gender, advanced age, ASA score >2, elevated white blood count and fever were confirmed as risk factors for EC. The EC group differed significantly from the control group with regard to fever (28.0 vs. 9.5 %), elevated WBC (82.5 vs. 62.3 %) and positive findings from ultrasound sonography (87.4 vs. 76.9 %), p < 0001. Surgery lasted significantly longer in the EC group (86.1 ± 38.5 vs. 72.2 ± 33.6, p < 0.001). The rates of conversion (15.2 vs. 5.8 %), bile duct injury (0.8 vs. 0.4 %), re-intervention (5.5 vs. 2.6 %) and mortality (2.8 vs. 1.2 %) were significantly higher in the EC group, p < 0.001. Similarly, the length of stay (11.9 ± 10.5 vs. 8.8 ± 8.3, p < 0.001) was significantly longer in the EC group.

Conclusion

Empyematous cholecystitis is a severe form of acute cholecystitis with high rates of morbidity and mortality. Even the experienced laparoscopic surgeon should expect dissection difficulties, therefore the threshold for conversion in order to prevent bile duct injury should be low.

Available only for authorised users

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

Ambe PC, Kohler L (2015) Is the male gender an independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis? Int Surg 100(5):854–859CrossRefPubMedPubMedCentral

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

Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Miura F, Wada K, Hirota M, Yamashita Y et al (2007) Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 14(1):11–14CrossRefPubMedPubMedCentral

Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1997) Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 21(5):540–545CrossRefPubMed

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

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

Ambe P, Esfahani BJ, Tasci I, Christ H, Kohler L (2011) Is laparoscopic cholecystectomy more challenging in male patients? Surg Endosc 25(7):2236–2240CrossRefPubMed

Ambe PC, Weber SA, Christ H, Wassenberg D (2015) Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res 27(6):921–926CrossRefPubMed

10.

Baron TH, Grimm IS, Swanstrom LL (2015) Interventional approaches to gallbladder disease. N Engl J Med 373(4):357–365CrossRefPubMed

11.

Dubecz A, Langer M, Stadlhuber RJ, Schweigert M, Solymosi N, Feith M, Stein HJ (2012) Cholecystectomy in the very elderly—is 90 the new 70? J Gastrointest Surg 16(2):282–285CrossRefPubMed

12.

Morse BC, Smith JB, Lawdahl RB, Roettger RH (2010) Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg 76(7):708–712PubMed

13.

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

14.

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

15.

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

16.

Aydin C, Altaca G, Berber I, Tekin K, Kara M, Titiz I (2006) Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg 13(2):155–159CrossRefPubMed

17.

Hunt DR, Chu FC (2000) Gangrenous cholecystitis in the laparoscopic era. Aust N Z J Surg 70(6):428–430CrossRefPubMed

18.

Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, Joehl RJ (1999) Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 126(4):680–685 (discussion 685–686) CrossRefPubMed

19.

Borzellino G, Sauerland S, Minicozzi AM, Verlato G, Di Pietrantonj C, de Manzoni G, Cordiano C (2008) Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc 22(1):8–15CrossRefPubMed

20.

Kwon YJ, Ahn BK, Park HK, Lee KS, Lee KG (2013) What is the optimal time for laparoscopic cholecystectomy in gallbladder empyema? Surg Endosc 27(10):3776–3780CrossRefPubMed

21.

Nikfarjam M, Niumsawatt V, Sethu A, Fink MA, Muralidharan V, Starkey G, Jones RM, Christophi C (2011) Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 13(8):551–558CrossRef

22.

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

23.

Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97(2):141–150CrossRefPubMed

24.

Kanakala V, Borowski DW, Pellen MG, Dronamraju SS, Woodcock SA, Seymour K, Attwood SE, Horgan LF (2011) Risk factors in laparoscopic cholecystectomy: a multivariate analysis. Int J Surg 9(4):318–323CrossRefPubMed

25.

Simopoulos C, Botaitis S, Polychronidis A, Trypsianis G, Perente S, Pitiakoudis M (2009) Laparoscopic cholecystectomy in patients with empyematous cholecystitis: an outcome analysis. Indian J Surg 71(5):258–264CrossRefPubMedPubMedCentral

26.

Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289(13):1639–1644CrossRefPubMed

27.

Thornton JR, Heaton KW, Espiner HJ, Eltringham WK (1983) Empyema of the gall bladder—reappraisal of a neglected disease. Gut 24(12):1183–1185CrossRefPubMedPubMedCentral

28.

Al-Jundi W, Cannon T, Antakia R, Anoop U, Balamurugan R, Everitt N, Ravi K (2012) Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience. Ann R Coll Surg Engl 94(2):99–101CrossRefPubMedPubMedCentral

29.

Ambe PC, Zirngibl H (2016) The fate of patients managed with percutaneous cholecystostomy for acute cholecystitis. Surgery 159(5):1479–1480CrossRefPubMed

30.

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 Percutan Tech 23(5):474–480CrossRefPubMed

31.

Smith TJ, Manske JG, Mathiason MA, Kallies KJ, Kothari SN (2013) Changing trends and outcomes in the use of percutaneous cholecystostomy tubes for acute cholecystitis. Ann Surg 257(6):1112–1115CrossRefPubMed

32.

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

33.

Anderson JE, Inui T, Talamini MA, Chang DC (2014) Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res 190(2):517–521CrossRefPubMed

Title: Surgical management of empyematous cholecystitis: a register study of over 12,000 cases from a regional quality control database in Germany
Authors: Peter C. Ambe
Stefan Jansen
Susanne Macher-Heidrich
Hubert Zirngibl
Publication date: 01-12-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-4882-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical management of empyematous cholecystitis: a register study of over 12,000 cases from a regional 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 12/2016

Does experience in hysteroscopy improve accuracy and inter-observer agreement in the management of abnormal uterine bleeding?

Convalescence after laparoscopic inguinal hernia repair: a qualitative systematic review

Endoscopic balloon dilation in the management of strictures in Crohn’s disease: a systematic review and meta-analysis of non-randomized trials

Minimal-invasive approach for penetrating Crohn’s disease is not associated with increased complications

Laparoscopic management of large hiatus hernia: five-year cohort study and comparison of mesh-augmented versus standard crura repair

Laparoscopic Puestow: lateral pancreaticojejunostomy