Top

Surgical Endoscopy

Published in:

01-07-2020 | Cholecystitis

Comparison of laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in aged acute calculous cholecystitis: a cohort study

Authors: Dengtian Lin, Shuodong Wu, Ying Fan, Changwei Ke

Published in: Surgical Endoscopy | Issue 7/2020

Abstract

Background

In elderly patients with calculous acute cholecystitis, the risk of emergency surgery is high, and percutaneous cholecystostomy tube drainage (PC) combined with delayed laparoscopic cholecystectomy (DLC) may be a good choice. We retrospectively compared laparoscopic cholecystectomy (LC) to DLC after PC to determine which is the better treatment strategy.

Method

We performed a retrospective cohort analysis of 752 patients with acute calculous cholecystitis. Patients with the following conditions were included: (1) age > 65 years old; (2) patients with a grade 2 or 3 severity of cholecystitis according to the 2013 Tokyo Guidelines (TG13); (3) the surgeons who performed the LC were professors or associate professors and (4) the DLC was performed in our hospital after PC. Patients who missed their 30-day follow-up; were diagnosed with bile duct stones, cholangitis or gallstone pancreatitis or were pregnant were excluded from the study. A total of 51 of 314 patients who underwent LC and 73 of 438 patients who underwent PC + DLC were assessed. PC + DLC and LC patients were matched by cholecystitis severity grade according to the TG13, and the National Surgical Quality Improvement Program (NSQIP) calculator was used to predict mortality (n = 21/group). Preoperative characteristics and postoperative outcomes were analysed.

Results

Compared to the matched LC group, the DLC group had less intraoperative bleeding (42.2 vs 75.3 mL, p = 0.014), shorter hospital stays (4.9 vs 7.4 days, p = 0.010) and lower rates of type A bile duct injury (4.8% vs 14.3%, p = 0.035) and type D (0 vs 9.5%, p = 0.002) according to Strasberg classification, residual stones (4.8 vs 14.3%, p = 0.035) and gastrointestinal organ injury (0 vs 3.6%, p < 0.001). Patients in the DLC group had lower incidences of ICU admission and death and a significantly lower incidence of repeat surgery.

Conclusion

In elderly patients treated for acute calculous cholecystitis, the 30-day mortality and complication rates were lower for PC + DLC than for LC. However, the total hospitalisation time was significantly prolonged and the costs were significantly higher for PC + DLC.

Malmstrom P, Olsson AM (1973) Cholecystostomy for acute cholecystitis. Am J Surg 126:397–402CrossRef

Gagic N, Frey CF (1975) The results of cholecystostomy for the treatment of acute cholecystitis. Surg Gynecol Obstet 140:255–257PubMed

Gingrich RA, Awe WC, Boyden AM, Peterson CG (1968) Cholecystostomy in acute cholecystitis. Factors influencing morbidity and mortality. Am J Surg 116:310–315CrossRef

Bonaventura A, Leale I, Carbone F, Liberale L, Dallegri F, Montecucco F, Borgonovo G (2018) Pre-surgery age-adjusted Charlson Comorbidity Index is associated with worse outcomes in acute cholecystitis. Dig Liver Dis 51:858–863CrossRef

Kim HO, Son BH, Yoo CH et al (2009) Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Surg Laparosc Endosc Percutan Tech 19(01):20–24CrossRef

Tan HY, Jiang DD et al (2018) Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy: a Meta-Analysis of Randomized Controlled Trials. J Laparoendosc Adv Surg Tech A 28(3):248–255. https://doi.org/10.1089/lap.2017.0514 CrossRefPubMed

Özkardeş AB, Tokaç M, Dumlu EG, Bozkurt B, Çiftçi AB, Yetişir F, Kılıç M (2014) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study. Int Surg 99:56–61CrossRef

Lee SW, Yang SS, Chang CS, Yeh HJ (2009) Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol 24:1857–1861. https://doi.org/10.1111/j.1440-1746.2009.05923.x CrossRefPubMed

El-Gendi A, El-Shafei M, Emara D (2017) Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade II acutecholecystitis patients. J Gastrointest Surg 21:284–293CrossRef

10.

Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125PubMed

11.

Asai K, Watanabe M, Kusachi S, Matsukiyo H, Saito T, Kodama H et al (2014) Risk factors for conversion of laparoscopic cholecystectomy to open surgery associated with the severity characteristics according to the Tokyo guidelines. Surg Today 44:2300–2304. https://doi.org/10.1007/s00595-014-0838-z CrossRefPubMed

12.

Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S (2000) Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 14:755–760. https://doi.org/10.1007/s004640000182 CrossRefPubMed

13.

Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ et al (2013) TG13 surgical management of acute cholecystitis. J Hepato-Biliary Pancreat Sci 20:89–96. https://doi.org/10.1007/s00534-012-0567-x CrossRef

14.

Zafar SN, Obirieze A, Adesibikan B, Cornwell EE 3rd, Fullum TM, Tran DD (2015) Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg 150:129–136CrossRef

15.

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 97:141–150CrossRef

16.

Welschbillig-Meunier K, Pessaux P, Lebigot J, Lermite E, Aube C, Brehant O, Hamy A, Arnaud JP (2005) Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc 19:1256–1259CrossRef

17.

Li M, Li N, Ji W, Quan Z, Wan X, Wu X, Li J (2013) Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg 79:524–527PubMed

18.

Inoue K, Ueno T, Nishina O, Douchi D, Shima K, Goto S, Takahashi M, Shibata C, Naito H (2017) Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis. BMC Gastroenterol 17:71CrossRef

19.

Laurila J, Syrjala H, Laurila PA, Saarnio J, Ala-Kokko TI (2004) Acute acalculous cholecystitis in critically Ill patients. Acta Anaesthesiol Scand 48:986–991. https://doi.org/10.1111/j.0001-5172.2004.00426.x CrossRefPubMed

20.

Davis CA, Landercasper J, Gundersen LH, Lambert PJ (1999) Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results. Arch Surg 134:727–731. https://doi.org/10.1001/archsurg.134.7.727 CrossRefPubMed

21.

Chopra S, Dodd GD III, Mumbower AL, Chintapalli KN, Schwesinger WH, Sirinek KR et al (2001) Treatment of acute cholecystitis in non-critically ill patients at high surgical risk: comparison of clinical outcomes after gallbladder aspiration and after percutaneous cholecystostomy. AJR Am J Roentgenol 176:1025–1031. https://doi.org/10.2214/ajr.176.4.1761025 CrossRefPubMed

22.

Inoue K, Ueno T, Douchi D, Shima K, Goto S, Takahashi M, Morikawa T, Naitoh T, Shibata C, Naito H (2017) Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013. BMC Surg 17:114. https://doi.org/10.1186/s12893-017-0319-6 CrossRefPubMedPubMedCentral

23.

Endo I, Takada T, Hwang TL, Akazawa K, Mori R, Miura F, Yokoe M, Itoi T, Gomi H, Chen MF, Jan YY, Ker CG, Wang HP, Kiriyama S, Wada K, Yamaue H, Miyazaki M, Yamamoto M (2017) Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study. J Hepato-Biliary Pancreat Sci 24(6):346–361CrossRef

24.

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

25.

Laurila J, Syrjala H, Laurila PA et al (2004) Acute acalculous cholecystitis in critically Ill patients. Acta Anaesthesiol Scand 48(8):986–991CrossRef

26.

Vaccari S, Lauro A, Cervellera M, Palazzini G, Casella G, Santoro A, Mascagni D, Ursi P, Gulotta E, D’errico U, Ussia A, De Siena N, Bianchini S, D’andrea V, Tonini V (2019) cholecystectomy for acute cholecystitis in octogenarians: impact of advanced age on post-operative outcome. Minerva Chir 74:289–296CrossRef

27.

Dimou FM, Adhikari D, Mehta HB, Riall TS (2017) Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis. J Am Coll Surg 224:502–511. https://doi.org/10.1016/j.jamcollsurg.2016.12.021 CrossRefPubMedPubMedCentral

28.

Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Miura F, Wada K, Hirota M, Yamashita Y, Strasberg S (2007) Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepato-Biliary Pancreat Surg 14:11–14CrossRef

29.

Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H et al (2012) New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepato-Biliary Pancreat Sci 19:578–585. https://doi.org/10.1007/s00534-012-0548-0 CrossRef

30.

Yokoe Masamichi, Takada Tadahiro, Strasberg Steven M, Solomkin Joseph S, Mayumi Toshihiko, Gomi Harumi, Pitt Henry A, James Garden O, Kiriyama Seiki, Hata Jiro, Gabata Toshifumi, Yoshida Masahiro, Miura Fumihiko, Okamoto Kohji, Tsuyuguchi Toshio, Itoi Takao, Yamashita Yuichi, Dervenis Christos, Chan Angus C W, Lau Wan-Yee, Supe Avinash N, Belli Giulio, Hilvano Serafin C, Liau Kui-Hin, Kim Myung-Hwan, Kim Sun-Whe, Ker Chen-Guo (2013) TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepato-Biliary Pancreat Sci 20:35–46CrossRef

31.

Thalji L, Shi Y, Hanson KT, Wakeam E, Habermann EB, Hyder JA (2019) Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children. J Anesth 33:372–380CrossRef

32.

Dave A, Beal EW, Lopez-Aguiar AG, Poultsides G, Makris E, Rocha FG, Kanji Z, Ronnekleiv-Kelly S, Rendell VR, Fields RC, Krasnick BA, Idrees K, Smith PM, Nathan H, Beems M, Maithel SK, Pawlik TM, Schmidt CR, Dillhoff ME (2019) Evaluating the ACS NSQIP risk calculator in primary pancreatic neuroendocrine tumor: results from the US neuroendocrine tumor study group. J Gastrointest Surg 1:1. https://doi.org/10.1007/s11605-019-04120-4 CrossRef

33.

Corkum KS, Baumann LM, Lautz TB (2019) Complication rates for pediatric hepatectomy and nephrectomy: a comparison of NSQIP-P, PHIS, and KID. J Surg Res 240:182–190CrossRef

34.

Sahara K, Paredes AZ, Merath K, Tsilimigras DI, Bagante F, Ratti F, Marques HP, Soubrane O et al (2019) Evaluation of the ACS NSQIP surgical risk calculator in elderly patients undergoing hepatectomy for hepatocellular carcinoma. J Gastrointest Surg 1:1. https://doi.org/10.1007/s11605-019-04174-4 CrossRef

35.

Boyd SS, O’Sullivan DM, Lasala C (2019) Evaluating postoperative morbidity in patients undergoing pelvic reconstructive surgery using the american college of surgeons national surgical quality improvement program surgical risk calculator. Female Pelvic Med Reconstr Surg 1:1. https://doi.org/10.1097/SPV.0000000000000715 CrossRef

36.

Augustine HFM, Hu J, Najarali Z, McRae M (2019) scoping review of the national surgical quality improvement program in plastic surgery research. Plast Surg (Oakv) 27(1):54–65CrossRef

37.

Lone Z, Hall S, Terakawa T, Hussein A, Ahmed Y, Elsayed AS, Aldhaam NA, May P, Miller A, Jing Z, Bagayrac LN, Khan H, Cohen J, Cole A, Rana O, Kanapan R, Prechtl C, Guru KA (2019) Accuracy of American College of Surgeons National Surgical Quality Improvement (ACS NSQIP^®) Universal Surgical Risk Calculator in Predicting Complications Following Robot-Assisted Radical Cystectomy at a National Comprehensive Cancer Center. J Endourol 33:383–388CrossRef

38.

Massoumi RL, Trevino CM, Webb TP (2017) Postoperative complications of laparoscopic cholecystectomy for acute cholecystitis: a comparison to the ACS-NSQIP risk calculator and the Tokyo Guidelines. World J Surg 41(4):935–939CrossRef

Title: Comparison of laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in aged acute calculous cholecystitis: a cohort study
Authors: Dengtian Lin
Shuodong Wu
Ying Fan
Changwei Ke
Publication date: 01-07-2020
Publisher: Springer US
Keywords: Cholecystitis
Cholecystectomy
Published in: Surgical Endoscopy / Issue 7/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07091-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Comparison of laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in aged acute calculous cholecystitis: a cohort study

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2020

Association of revisions or conversions after sleeve gastrectomy with annual bariatric center procedural volume in the state of New York

Cognitive load in 3d and 2d minimally invasive colorectal surgery

A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy

Patients support transfer of care for unexpected findings in laparoscopic cholecystectomy

Can we better predict readmission for dehydration following creation of a diverting loop ileostomy: development and validation of a prediction model and web-based risk calculator

Laparoscopic resection with complete mesocolic excision for splenic flexure cancer: long-term follow-up data from a multicenter retrospective study