Comparative analysis of surgery for acute cholecystitis: before and after national recommendations acceptance
https://doi.org/10.16931/1995-5464.2018284-91
Abstract
Aim. To determine the ways to reduce postoperative morbidity and mortality in acute cholecystitis. Material and metods. Retrospective (2013–2014 years) and prospective non-randomized (2015–2016) analysis of outcomes in 804 patients with acute cholecystitis was performed. Analysis was carried out within two periods – before and after acceptance of national clinical recommendations “Acute cholecystitis” (2015). Protocols of diagnosis and treatment developed by our clinic were applied in the first period (2013–2014). 220 patients (group I) underwent surgery in the first period, 290 (group II) – in the second period. Results. There was significantly reduced incidence of conversions for laparoscopic and minimally invasive cholecystectomy from 4.09% to 2.41% (p < 0.05) (OR – 1.724; 95% CI 0.632–4.705). Incidence of extrahepatic bile ducts lesion, postoperative thrombotic, thromboembolic complications, cardiovascular complications (including myocardial infarction) were similar in both groups (p > 0.05) (for cardiovascular complications OR – 0.758, 95% CI 0.047–12.183). There was reduced length of hospital-stay from 11.5 ± 0.8 to 9 ± 0.5 days (p < 0.05). Slight augmentation of postoperative mortality in the second period (from 0.45% to 1.37%) was observed (p < 0.05) (OR – 3.063, 95% CI 0.340–27.599). Conclusion. Reduced number of conversions was predominantly caused by cholecystectomy in patients with milder gallbladder inflammation. It is explained by earlier surgery (within 24–48 h) when severe infiltration of surrounding tissues is absent. Preoperative prolonged medication (3–5 days) aggravates these processes, creates significant intraoperative technical difficulties and increases incidence of conversions.
About the Authors
V. M. Timerbulatov
Institute of Additional Professional Education of the Bashkir State Medical University of Healthcare Ministry of Russia
Russian Federation
Doct. of Med. Sci., Professor, Corresponding-Member of RAS, Head of the Chair of Surgery with the Course of Endoscopy and in In-Patient Substitution Technologies of the Institute of Additional Professional Education of the Bashkir State Medical University
Russian Federation
Doct. of Med. Sci., Professor, Corresponding-Member of RAS, Head of the Chair of Surgery with the Course of Endoscopy and in In-Patient Substitution Technologies of the Institute of Additional Professional Education of the Bashkir State Medical University
Sh. V. Timerbulatov
Institute of Additional Professional Education of the Bashkir State Medical University of Healthcare Ministry of Russia
Russian Federation
Doct. of Med. Sci., Professor of the Chair of Surgery with the Course of Endoscopy and in In-Patient Substitution Technologies of the Institute of Additional Professional Education of the Bashkir State Medical University
Russian Federation
Doct. of Med. Sci., Professor of the Chair of Surgery with the Course of Endoscopy and in In-Patient Substitution Technologies of the Institute of Additional Professional Education of the Bashkir State Medical University
R. M. Garipov
Institute of Additional Professional Education of the Bashkir State Medical University of Healthcare Ministry of Russia
Russian Federation
Doct. of Med. Sci., Professor of the Chair of Surgery with the Course of Endoscopy and in In-Patient Substitution Technologies of the Institute of Additional Professional Education of the Bashkir State Medical University
Russian Federation
Doct. of Med. Sci., Professor of the Chair of Surgery with the Course of Endoscopy and in In-Patient Substitution Technologies of the Institute of Additional Professional Education of the Bashkir State Medical University
A. M. Sargsyan
Ufa Emergency Hospital” of Healthcare Ministry of the Republic of Bashkortostan
Russian Federation
Surgeon at the Ufa Emergency Hospital of Healthcare Ministry of the Republic of Bashkortostan
Russian Federation
Surgeon at the Ufa Emergency Hospital of Healthcare Ministry of the Republic of Bashkortostan
References
1. Рекомендуемые протоколы оказания неотложной хирургической помощи населению. Под ред. чл.-корр. РАН, проф. В.М. Тимербулатова. Уфа: Гилем, 2008. 73 с.
2. Чан Ючун. Прогностический анализ результатов отсроченной лапароскопической холецистэктомии при воспалительных изменениях желчного пузыря. Анналы хирургической гепатологии. 2016; 21 (1): 59–77. DOI: 10.16931/1995-5464.2016159-77.
3. Chang Y.C. A proposed inflammation grading system for laparoscopic cholecystectomy. Hepatogastroenterology. 2005; 52 (61): 33–36.
4. Germanos S., Gourgiotis S., Kocher H.M. Clinical update: early surgery for acute cholecystitis. Lancet. 2007; 369 (5): 1774–1776.
5. Gurusamy K., Samraj K., Gluud C., Wilson E., Davidson B.R. 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): 141–150. DOI: 10.1002/bjs.6870.
6. Papi С., Catarci M., D'Ambrosio L., Gili L., Koch M., Grassi G.B., Capurso L. Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am. J. Gastroenterol. 2004; 99 (1): 147–155.
7. Cheruvu C.V., Eyre-Brook I.A. Consequences of prolonged wait before gallbladder surgery. Ann. R. Coll. Surg. Engl. 2002; 84 (1): 20–22.
8. Siddiqui T., MacDonald A., Chong P.S., Jenkins J.T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am. J. Surg. 2008; 195 (1): 40–47.
9. Macafee D.A., Humes D.J., Bouliotis G., Beckingham I.J., Whynes D.K., Lobo D.N. Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br. J. Surg. 2009; 96 (9): 1031–1040. DOI: 10.1002/bjs.6685.
10. Johansson M., Thune A., Blomqvist A., Nelvin L., Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J. Gastrointest. Surg. 2003; 7 (5): 642–645. DOI: 10.1016/S1091-255X(03)00065-9.
11. Stevens K.A., Chi A., Lucas L.C., Porter J.M., Williams M.D. Immediate laparoscopic cholecystectomy for acute cholecystitis: no need to wait. Am. J. Surg. 2006; 192 (6): 756–761. DOI: 10.1016/j.amjsurg.2006.08.040.
12. Lau H., Lo C.Y., Patil N.G., Yuen W.K. Early versus delayedinterval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg. Endosc. 2006; 20 (1): 82–87. DOI: 10.1007/s00464-005-0100-2.
Review
For citations:
Timerbulatov V.M., Timerbulatov Sh.V., Garipov R.M., Sargsyan A.M. Comparative analysis of surgery for acute cholecystitis: before and after national recommendations acceptance. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2018;23(2):84-92. (In Russ.) https://doi.org/10.16931/1995-5464.2018284-91
Views:
517
Email this article 