Severe Acute Cholecystitis (Tokyo III) in High-Risk Patients: Should Cholecystectomy Be Preferred over Percutaneous Drainage?
Fecha
2023Autor
Resumen
Current guidelines advise the use of less aggressive procedures for the solution of cholecystitis in high risk patients. However, recent literature has shown better results in those patients managed with laparoscopic cholecystectomy . We aim to describe outcomes in high-risk patients with severe acute cholecystitis (Tokyo III) according to 2018 guidelines. Methods Patients that underwent laparoscopic cholecystectomy and percutaneous drainage by cholecystostomy between January 2018 and January 2020 were included in descriptive analysis. Bivariate analysis of Tokyo III patients was performed between variables involved. Results A total of 622 patients were included. 54.66% of patients were female. The mean age was 66.6 ± 16.52 years. 288 patients were classified as grade III in Tokyo classification, 28.98% underwent cholecystostomy and 71.02% cholecystectomy. Mortality and complication rate had no significant differences between the groups (p = 0.09 - p = 0.1 respectively). The in-hospital length of stay was significantly higher in patients that required cholecystostomy with a mean of 15.43 days versus 9.97 days in the LC group, with a statistically significant difference (p 0.000 CI 95%) . Conclusions Laparoscopic cholecystectomy seems to be a feasible treatment choice over percutaneous cholecystostomy in terms of mortality, reintervention and in-hospital stay length.
Abstract
Current guidelines advise the use of less aggressive procedures for the solution of cholecystitis in high risk patients. However, recent literature has shown better results in those patients managed with laparoscopic cholecystectomy . We aim to describe outcomes in high-risk patients with severe acute cholecystitis (Tokyo III) according to 2018 guidelines. Methods Patients that underwent laparoscopic cholecystectomy and percutaneous drainage by cholecystostomy between January 2018 and January 2020 were included in descriptive analysis. Bivariate analysis of Tokyo III patients was performed between variables involved. Results A total of 622 patients were included. 54.66% of patients were female. The mean age was 66.6 ± 16.52 years. 288 patients were classified as grade III in Tokyo classification, 28.98% underwent cholecystostomy and 71.02% cholecystectomy. Mortality and complication rate had no significant differences between the groups (p = 0.09 - p = 0.1 respectively). The in-hospital length of stay was significantly higher in patients that required cholecystostomy with a mean of 15.43 days versus 9.97 days in the LC group, with a statistically significant difference (p 0.000 CI 95%) . Conclusions Laparoscopic cholecystectomy seems to be a feasible treatment choice over percutaneous cholecystostomy in terms of mortality, reintervention and in-hospital stay length.
Keywords
URI
http://repositorio.mederi.com.co/handle/123456789/772https://journals.lww.com/journalacs/pages/default.aspx
Colecciones
- Investigación clínica [389]