Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2015

Open Access 01-12-2015 | Research article

Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation

Authors: Marios Papadakis, Peter C. Ambe, Hubert Zirngibl

Published in: World Journal of Emergency Surgery | Issue 1/2015

Login to get access

Abstract

Background

Acute cholecystitis is a common diagnosis and surgery is the standard of care for young and fit patients. However, due to high risk of postoperative morbidity and mortality, surgical management of critically ill patients remains a controversy. It is not clear, whether the increased risk of perioperative complications associated with the management of critically ill patients with acute cholecystitis is secondary to reduced physiologic reserve per se or to the severity of gallbladder inflammation.

Methods

A retrospective analysis of prospectively collected data of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a university hospital over a three-year-period was performed. The ASA scores at the time of presentation were used to categorize patients into two groups. The study group consisted of critically ill patients with ASA 3 and 4, while the control group was made up of fit patients with ASA 1 and 2. Both groups were compared with regard to perioperative data, postoperative outcome and extent of gallbladder inflammation on histopathology.

Results

Two hundred and seventeen cases of acute cholecystitis with complete charts were available for analysis. The study group included 67 critically ill patients with ASA 3 and 4, while the control group included 150 fit patients with ASA 1 and 2. Both groups were comparable with regard to perioperative data. Histopathology confirmed severe cholecystitis in a significant number of cases in the study group compared to the control group (37 % vs. 18 %, p = 0.03). Significantly higher rates of morbidity and mortality were recorded in the study group (p < 0.05). Equally, significantly more patients from the study group were managed in the ICU (40 % vs. 8 %, p = 0.001).

Conclusion

Critically ill patients presenting with acute cholecystitis are at increased risk for extensive gallbladder inflammation. The increased risk of morbidity and mortality seen in such patients might partly be secondary to severe acute cholecystitis.
Literature
1.
Ambe P, Weber SA, Christ H, Wassenberg D. 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 emergency surgery : WJES. 2014;9(1):60.PubMedCentralCrossRef
2.
Degrate L, Ciravegna AL, Luperto M, Guaglio M, Garancini M, Maternini M, et al. Acute cholecystitis: The golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients. Langenbecks Arch Surg. 2013;398(8):1129–36.CrossRefPubMed
3.
Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97(2):141–50.CrossRefPubMed
4.
Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, et al. Acute cholecystitis: Early versus delayed cholecystectomy, a multicenter randomized trial (ACDC Study, NCT00447304). Ann Surg. 2013;258(3):385–91.CrossRefPubMed
5.
Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004;18(9):1323–7.CrossRefPubMed
6.
Lau B, DiFronzo LA. An acute care surgery model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis. Am Surg. 2011;77(10):1318–21.PubMed
7.
Papi C, Catarci M, D’Ambrosio L, Gili L, Koch M, Grassi GB, et al. Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol. 2004;99(1):147–55.CrossRefPubMed
8.
Siddiqui T, MacDonald A, Chong PS, Jenkins JT. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195(1):40–7.CrossRefPubMed
9.
Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001;15(7):700–5.CrossRefPubMed
10.
Kapan M, Onder A, Tekbas G, Gul M, Aliosmanoglu I, Arikanoglu Z, et al. Percutaneous cholecystostomy in high-risk elderly patients with acute cholecystitis: a lifesaving option. Am J Hospice and Palliat Med. 2013;30(2):167–71.CrossRef
11.
Li M, Li N, Ji W, Quan Z, Wan X, Wu X, et al. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg. 2013;79(5):524–7.PubMed
12.
McGillicuddy EA, Schuster KM, Barre K, Suarez L, Hall MR, Kaml GJ, et al. Non-operative management of acute cholecystitis in the elderly. Br J Surg. 2012;99(9):1254–61.CrossRefPubMed
13.
Morse BC, Smith JB, Lawdahl RB, Roettger RH. Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg. 2010;76(7):708–12.PubMed
14.
Nielsen LBJ, Harboe KM, Bardram L. Cholecystectomy for the elderly: no hesitation for otherwise healthy patients. Surg Endosc. 2014;28(1):171-177.
15.
Qasaimeh GR, Banihani MN. Laparoscopic cholecystectomy in the elderly and young: A comparative study. Hepatogastroenterology. 2012;59(113):22–5.PubMed
16.
Vracko J, Markovic S, Wiechel KL. Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk. Endoscopy. 2006;38(8):773–8.CrossRefPubMed
17.
Ambe PC, Weber SA, Christ H, Wassenberg D. Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res. 2015;27(6):921-6.
18.
Borzellino G, Sauerland S, Minicozzi AM, Verlato G, Di Pietrantonj C, de Manzoni G, et al. Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc. 2008;22(1):8–15.CrossRefPubMed
19.
Simorov A, Ranade A, Parcells J, Shaligram A, Shostrom V, Boilesen E, et al. Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: A large multicenter outcome study. Am J Surg. 2013;206(6):935–41.CrossRefPubMed
20.
Tarragón AV, Soria JSA, Lens V, Manzoni D, Fabiano P, Goergen M. Two staged minimally invasive treatment for acute cholecystitis in high risk patients. Hepatogastroenterology. 2013;60(123):466–9.
21.
Zerem E, Omerović S, Imširović B. Is surgical cholecystectomy better than percutaneous in treatment of acute cholecystitis in patients unfit for surgery? J Gastrointest Surg. 2013;17(8):1542–3.CrossRefPubMed
22.
Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):35–46.CrossRefPubMed
23.
Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2012;19(5):578–85.PubMedCentralCrossRefPubMed
24.
Ambe PC, Christ H, Wassenberg D. Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis. BMC Gastroenterol. 2015;15(1):142.PubMedCentralCrossRefPubMed
25.
Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):15–26.PubMedCentralCrossRefPubMed
26.
Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77(2):217–22.CrossRefPubMed
27.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedCentralCrossRefPubMed
28.
Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc. 2006;20(1):82–7.CrossRefPubMed
29.
Ambe P, Esfahani BJ, Tasci I, Christ H, Köhler L. Is laparoscopic cholecystectomy more challenging in male patients? Surg Endosc and Other Interventional Techniques. 2011;25(7):2236–40.CrossRef
30.
Botaitis S, Polychronidis A, Pitiakoudis M, Perente S, Simopoulos C. Does gender affect laparoscopic cholecystectomy? Surg Laparosc Endosc Percutan Tech. 2008;18(2):157–61.CrossRefPubMed
31.
Ibrahim S, Hean TK, Ho LS, Ravintharan T, Chye TN, Chee CH. Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy. World J Surg. 2006;30(9):1698–704.CrossRefPubMed
32.
Kanakala V, Borowski DW, Pellen MG, Dronamraju SS, Woodcock SA, Seymour K, et al. Risk factors in laparoscopic cholecystectomy: a multivariate analysis. Int J Surg (London, England). 2011;9(4):318–23.CrossRef
33.
Lee HK, Han HS, Min SK, Lee JH. Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2005;92(4):463–6.CrossRefPubMed
34.
Fagan SP, Awad SS, Rahwan K, Hira K, Aoki N, Itani KM, et al. Prognostic factors for the development of gangrenous cholecystitis. Am J Surg. 2003;186(5):481–5.CrossRefPubMed
35.
Hunt DR, Chu FC. Gangrenous cholecystitis in the laparoscopic era. Aust N Z J Surg. 2000;70(6):428–30.CrossRefPubMed
36.
Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, et al. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery. 1999;126(4):680–5. discussion 685–686.CrossRefPubMed
37.
Wilson AK, Kozol RA, Salwen WA, Manov LJ, Tennenberg SD. Gangrenous cholecystitis in an urban VA hospital. J Surg Res. 1994;56(5):402–4.CrossRefPubMed
38.
Zhu B, Zhang Z, Wang Y, Gong K, Lu Y, Zhang N. Comparison of laparoscopic cholecystectomy for acute cholecystitis within and beyond 72 h of symptom onset during emergency admissions. World J Surg. 2012;36(11):2654–8.CrossRefPubMed
39.
Kortram K, van Ramshorst B, Bollen TL, Besselink MGH, Gouma DJ, Karsten T, Kruyt PM, Nieuwenhuijzen GAP, Kelder JC, Tromp E et al.. Acute cholecystitis in high risk surgical patients: Percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial. Trials. 2012, 13. doi:10.​1186/​1745-6215-13-7.
40.
Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, et al. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):89–96.CrossRefPubMed
41.
Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev. 2013;6:CD005440.PubMed
Metadata
Title
Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation
Authors
Marios Papadakis
Peter C. Ambe
Hubert Zirngibl
Publication date
01-12-2015
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2015
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-015-0054-1

Other articles of this Issue 1/2015

World Journal of Emergency Surgery 1/2015 Go to the issue

Review

Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment

Commentary

Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

Research article

Elevated white blood cell count, decreased hematocrit and presence of macrohematuria correlate with abdominal organ injury in pediatric blunt trauma patients: a retrospective study

Research article

Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania

Research article

Foregut caustic injuries: results of the world society of emergency surgery consensus conference

Review

Liver trauma: WSES position paper