Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases
Autor(a) principal: | |
---|---|
Data de Publicação: | 2014 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258 |
Resumo: | Introduction: Despite the skepticism with which it was initially seen, laparoscopic cholecystectomy is now the technique of choice for acute cholecystitis. It is, however, important to evaluate the results in comparison with classic cholecystectomy, since the latter is still used by some surgeons in certain situations.Material and Methods: Our research corresponds to the analysis of 520 patients operated on for acute cholecystitis performed in the department of surgery at the São João Hospital in Oporto - 412 (79.2%) laparoscopic cholecystectomies and 108 (20.8%) open cholecystectomies - from 2007 to 2013. We evaluated comorbidities, leukocytosis, time between diagnosis and surgery, ASA, per and postoperative complications, mortality, reoperations, lesion of main bile duct, conversion rate and hospital stay, in order to compare these two techniques. The conversion group was included in laparoscopic cholecystectomy. Statistical analysis was based on descriptive statistic procedures and the evaluation of contrast between groups was based on Fishers’ exact test. Significant values were considered for p < 0.05.Results: Laparoscopic Cholecystectomy versus Open Cholecystectomy: Mortality: 0.7% vs 3,7% (p = 0.0369); Peroperative complications: 3.6% vs 12.9% (p = 0.0006); Surgical postoperative complications: 7.7% vs 17.5% (p = 0.0055); Medical postoperative complications: 4.3% vs 5.5% (p = 0.6077); Lesion of the main bile duct: 0.9% vs 1.8% (p = 0.6091); Reoperation: 2.9% vs 5.5% (p = 0.2315); Hospital stay up to 4 days after surgery: 64.8% vs 18.5% (p < 0.001). The convertion rate was of 10.7%: 8.8% in early surgery (before 4 days after de diagnosis) and 13.7% in the late surgery (after this time but in the same stay) (p = 0.1425). Multiple causes led to convertion: surgical complications (biliary lesions, iatrogenic lesion of the small bowel, perfurations of the gallbladder with spillage of stones); complications during the pneumoperitoneum, unclear anatomy and scoliosis. Postoperative complications in laparoscopic cholecystectomies converted group vs non-converted: surgical 20.4% vs 6.2% (p = 0.0034) and medical 6.8% vs 4.1% (p = 0.4484).Discussion: There are few investigations concerning the comparison of laparoscopic cholecystectomy vs acute cholecystitis in patients with acute cholecystitis, corresponding mostly to multicenter studies. For this reason, we carry out an analysis inherent to 520 patients operated on with that disease in the surgery department of Hospital S. João in Oporto of which 412 were by laparoscopic cholecystectomy and 108 by acute cholecystitis. We found better results in laparoscopic cholecystectomy than in acute cholecystitis with respect to mortality, per and post-operative surgical complications and hospital stay. The incidence of main bile duct injury, medicalcomplications and reoperations, although less evident in laparoscopic cholecystectomy, were not statistically significant. There were more complications in the group of laparoscopic cholecystectomy converted than in those where it was not be necessary the conversion. This raises the need, in complications during the laparoscopic cholecystectomy, not to perform the conversion too late. The analysis of this study, therefore, properly values laparoscopic cholecystectomy in the surgery of patients with acute cholecystitis.Conclusion: The results justify the frequency with which laparoscopic cholecystectomy is performed in acute cholecystitis, in comparison to open surgery, thus taking an increasingly prominent place in the treatment of this disease.Keywords: Cholecystectomy, Laparoscopic; Cholecystectomy; Cholecystitis. |
id |
RCAP_6bdb95742b7226f3cbbdac249031c150 |
---|---|
oai_identifier_str |
oai:ojs.www.actamedicaportuguesa.com:article/5258 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 CasesColecistectomia por Laparoscopia e por Laparotomia na Colecistite Aguda: Análise Crítica de 520 CasosIntroduction: Despite the skepticism with which it was initially seen, laparoscopic cholecystectomy is now the technique of choice for acute cholecystitis. It is, however, important to evaluate the results in comparison with classic cholecystectomy, since the latter is still used by some surgeons in certain situations.Material and Methods: Our research corresponds to the analysis of 520 patients operated on for acute cholecystitis performed in the department of surgery at the São João Hospital in Oporto - 412 (79.2%) laparoscopic cholecystectomies and 108 (20.8%) open cholecystectomies - from 2007 to 2013. We evaluated comorbidities, leukocytosis, time between diagnosis and surgery, ASA, per and postoperative complications, mortality, reoperations, lesion of main bile duct, conversion rate and hospital stay, in order to compare these two techniques. The conversion group was included in laparoscopic cholecystectomy. Statistical analysis was based on descriptive statistic procedures and the evaluation of contrast between groups was based on Fishers’ exact test. Significant values were considered for p < 0.05.Results: Laparoscopic Cholecystectomy versus Open Cholecystectomy: Mortality: 0.7% vs 3,7% (p = 0.0369); Peroperative complications: 3.6% vs 12.9% (p = 0.0006); Surgical postoperative complications: 7.7% vs 17.5% (p = 0.0055); Medical postoperative complications: 4.3% vs 5.5% (p = 0.6077); Lesion of the main bile duct: 0.9% vs 1.8% (p = 0.6091); Reoperation: 2.9% vs 5.5% (p = 0.2315); Hospital stay up to 4 days after surgery: 64.8% vs 18.5% (p < 0.001). The convertion rate was of 10.7%: 8.8% in early surgery (before 4 days after de diagnosis) and 13.7% in the late surgery (after this time but in the same stay) (p = 0.1425). Multiple causes led to convertion: surgical complications (biliary lesions, iatrogenic lesion of the small bowel, perfurations of the gallbladder with spillage of stones); complications during the pneumoperitoneum, unclear anatomy and scoliosis. Postoperative complications in laparoscopic cholecystectomies converted group vs non-converted: surgical 20.4% vs 6.2% (p = 0.0034) and medical 6.8% vs 4.1% (p = 0.4484).Discussion: There are few investigations concerning the comparison of laparoscopic cholecystectomy vs acute cholecystitis in patients with acute cholecystitis, corresponding mostly to multicenter studies. For this reason, we carry out an analysis inherent to 520 patients operated on with that disease in the surgery department of Hospital S. João in Oporto of which 412 were by laparoscopic cholecystectomy and 108 by acute cholecystitis. We found better results in laparoscopic cholecystectomy than in acute cholecystitis with respect to mortality, per and post-operative surgical complications and hospital stay. The incidence of main bile duct injury, medicalcomplications and reoperations, although less evident in laparoscopic cholecystectomy, were not statistically significant. There were more complications in the group of laparoscopic cholecystectomy converted than in those where it was not be necessary the conversion. This raises the need, in complications during the laparoscopic cholecystectomy, not to perform the conversion too late. The analysis of this study, therefore, properly values laparoscopic cholecystectomy in the surgery of patients with acute cholecystitis.Conclusion: The results justify the frequency with which laparoscopic cholecystectomy is performed in acute cholecystitis, in comparison to open surgery, thus taking an increasingly prominent place in the treatment of this disease.Keywords: Cholecystectomy, Laparoscopic; Cholecystectomy; Cholecystitis.Introdução: Apesar do cepticismo com que inicialmente foi encarada, a colecistectomia laparoscópica é hoje a técnica de eleição na colecistite aguda. Torna-se, porém, importante avaliar os seus resultados, em comparação com a colecistectomia clássica, uma vez que esta última ainda é seguida por alguns cirurgiões em determinadas situações.Material e Métodos: No nosso estudo foram incluídos 520 doentes com colecistites agudas operados no Serviço de Cirurgia Geral do Hospital de S. João, entre 2007 e 2013, dos quais 412 (79,2%) por laparoscopia e 108 (20,8%) por via aberta, com uma incidência de conversão de 10,7%. Procedeu-se ao estudo relativo às doenças coexistentes, leucocitose, tempo decorrido entre o diagnóstico na urgência e a cirurgia, classificação ASA, complicações intra e pós-operatórias, mortalidade, reintervenções, lesão biliar e estadia hospitalar. Os doentes convertidos foram incluídos no grupo das colecistectomias laparoscópicas. A análise estatística baseou-se em processos descritivos e a avaliação das diferenças entre grupos foi realizada com base no teste exato de Fisher, sendo considerados valores significativos para p < 0,05.Resultados: Colecistectomia laparoscópica versus Colecistectomia aberta: Mortalidade: 0,7% vs 3,7% (p = 0,0369); Complicações per-operatórias: 3,6% vs 12,9% (p = 0,0006); Complicações pós-operatórias cirúrgicas: 7,7% vs 17,5% (p = 0,0055); Pós-operatórias médicas: 4,3% vs 5,5% (p = 0,6077); Lesão da via biliar principal: 0,9% vs 1,8% (p = 0,6091); Reintervenções: 2,9% vs 5,5% (p = 0,2315); Internamento hospitalar inferior ou igual a quatro dias: 64,8% vs 18,5% (p < 0,0001). Na colecistectomia laparoscópica houve 10,7% de conversões: nas precoces (intervenções realizadas antes das 96 h após o diagnóstico na urgência) esta taxa foi de 8,8% e nas tardias (após aquele período de tempo mas no mesmo internamento) de 13,7% (p = 0,1425); Complicações nos doentes convertidos vs não convertidos: nas cirúrgicas 20,4% vs 6,2% (p = 0,0034) e nas médicas 6,8% vs 4,1% (p = 0,4484). As causas de conversãoforam condicionadas por complicações cirúrgicas (lesões biliares, lacerações entéricas, perfurações vesiculares com a disseminação de cálculos), intolerância ao pneumoperitoneo, indefinição do pedículo biliar e escoliose.Discussão: Há poucas investigações relativas à comparação da colecistectomia laparoscópica vs colecistectomia aberta nos doentes com colecistectomia aberta, correspondendo a maior parte delas a estudos multicêntricos. Por esta razão, julgamos de interesse proceder a uma análise inerente a 520 operados com aquela doença no Serviço de Cirurgia Geral do Hospital de S. João dos quais 412 por colecistectomia laparoscópica e 108 por colecistectomia aberta. Verificamos na colecistectomia laparoscópica melhores resultados do que na colecistectomia aberta no que se refere à mortalidade, complicações per e pós-operatórias cirúrgicas e estadia hospitalar. A incidência da via biliar principal, complicações médicas e reintervenções, embora menos evidentes na colecistectomia laparoscópica, não se revelaram com significado estatístico. Merece referência o maior número de complicações no grupo das colecistectomias laparoscópicasconvertidas do que naquelas em que tal não foi necessário confirmando-se, assim, o já referido em estudos multicêntricos citados na literatura. Este facto levanta a necessidade de, mediante complicações ocorridas durante a colecistectomia laparoscópica, não se proceder à conversão tardiamente. A análise do presente estudo valoriza, assim, devidamente a colecistectomia laparoscópica na cirurgia dos doentes com colecistite aguda.Conclusão: Os resultados obtidos justificam a frequência com que a colecistectomia laparoscópica é realizada na colecistite aguda, em comparação com a via aberta, ocupando cada vez mais, um lugar primordial, no tratamento desta doença.Palavras-chave: Colecistectomia Laparoscópica; Colecistectomia; Colecistite.Ordem dos Médicos2014-12-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258oai:ojs.www.actamedicaportuguesa.com:article/5258Acta Médica Portuguesa; Vol. 27 No. 6 (2014): November-December; 685-691Acta Médica Portuguesa; Vol. 27 N.º 6 (2014): Novembro-Dezembro; 685-6911646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/4147https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/4244https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/7153https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/7298https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/7465Teixeira, João AraújoRibeiro, CarlosMoreira, Luís M.Sousa, Fabiana dePinho, AndréGraça, LuísMaia, José Costainfo:eu-repo/semantics/openAccess2022-12-20T11:04:16Zoai:ojs.www.actamedicaportuguesa.com:article/5258Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:03.414260Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases Colecistectomia por Laparoscopia e por Laparotomia na Colecistite Aguda: Análise Crítica de 520 Casos |
title |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases |
spellingShingle |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases Teixeira, João Araújo |
title_short |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases |
title_full |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases |
title_fullStr |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases |
title_full_unstemmed |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases |
title_sort |
Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute Cholecystitis: Critical Analysis of 520 Cases |
author |
Teixeira, João Araújo |
author_facet |
Teixeira, João Araújo Ribeiro, Carlos Moreira, Luís M. Sousa, Fabiana de Pinho, André Graça, Luís Maia, José Costa |
author_role |
author |
author2 |
Ribeiro, Carlos Moreira, Luís M. Sousa, Fabiana de Pinho, André Graça, Luís Maia, José Costa |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Teixeira, João Araújo Ribeiro, Carlos Moreira, Luís M. Sousa, Fabiana de Pinho, André Graça, Luís Maia, José Costa |
description |
Introduction: Despite the skepticism with which it was initially seen, laparoscopic cholecystectomy is now the technique of choice for acute cholecystitis. It is, however, important to evaluate the results in comparison with classic cholecystectomy, since the latter is still used by some surgeons in certain situations.Material and Methods: Our research corresponds to the analysis of 520 patients operated on for acute cholecystitis performed in the department of surgery at the São João Hospital in Oporto - 412 (79.2%) laparoscopic cholecystectomies and 108 (20.8%) open cholecystectomies - from 2007 to 2013. We evaluated comorbidities, leukocytosis, time between diagnosis and surgery, ASA, per and postoperative complications, mortality, reoperations, lesion of main bile duct, conversion rate and hospital stay, in order to compare these two techniques. The conversion group was included in laparoscopic cholecystectomy. Statistical analysis was based on descriptive statistic procedures and the evaluation of contrast between groups was based on Fishers’ exact test. Significant values were considered for p < 0.05.Results: Laparoscopic Cholecystectomy versus Open Cholecystectomy: Mortality: 0.7% vs 3,7% (p = 0.0369); Peroperative complications: 3.6% vs 12.9% (p = 0.0006); Surgical postoperative complications: 7.7% vs 17.5% (p = 0.0055); Medical postoperative complications: 4.3% vs 5.5% (p = 0.6077); Lesion of the main bile duct: 0.9% vs 1.8% (p = 0.6091); Reoperation: 2.9% vs 5.5% (p = 0.2315); Hospital stay up to 4 days after surgery: 64.8% vs 18.5% (p < 0.001). The convertion rate was of 10.7%: 8.8% in early surgery (before 4 days after de diagnosis) and 13.7% in the late surgery (after this time but in the same stay) (p = 0.1425). Multiple causes led to convertion: surgical complications (biliary lesions, iatrogenic lesion of the small bowel, perfurations of the gallbladder with spillage of stones); complications during the pneumoperitoneum, unclear anatomy and scoliosis. Postoperative complications in laparoscopic cholecystectomies converted group vs non-converted: surgical 20.4% vs 6.2% (p = 0.0034) and medical 6.8% vs 4.1% (p = 0.4484).Discussion: There are few investigations concerning the comparison of laparoscopic cholecystectomy vs acute cholecystitis in patients with acute cholecystitis, corresponding mostly to multicenter studies. For this reason, we carry out an analysis inherent to 520 patients operated on with that disease in the surgery department of Hospital S. João in Oporto of which 412 were by laparoscopic cholecystectomy and 108 by acute cholecystitis. We found better results in laparoscopic cholecystectomy than in acute cholecystitis with respect to mortality, per and post-operative surgical complications and hospital stay. The incidence of main bile duct injury, medicalcomplications and reoperations, although less evident in laparoscopic cholecystectomy, were not statistically significant. There were more complications in the group of laparoscopic cholecystectomy converted than in those where it was not be necessary the conversion. This raises the need, in complications during the laparoscopic cholecystectomy, not to perform the conversion too late. The analysis of this study, therefore, properly values laparoscopic cholecystectomy in the surgery of patients with acute cholecystitis.Conclusion: The results justify the frequency with which laparoscopic cholecystectomy is performed in acute cholecystitis, in comparison to open surgery, thus taking an increasingly prominent place in the treatment of this disease.Keywords: Cholecystectomy, Laparoscopic; Cholecystectomy; Cholecystitis. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-12-30 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258 oai:ojs.www.actamedicaportuguesa.com:article/5258 |
url |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258 |
identifier_str_mv |
oai:ojs.www.actamedicaportuguesa.com:article/5258 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/4147 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/4244 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/7153 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/7298 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5258/7465 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf application/vnd.openxmlformats-officedocument.wordprocessingml.document application/vnd.openxmlformats-officedocument.wordprocessingml.document application/pdf |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
publisher.none.fl_str_mv |
Ordem dos Médicos |
dc.source.none.fl_str_mv |
Acta Médica Portuguesa; Vol. 27 No. 6 (2014): November-December; 685-691 Acta Médica Portuguesa; Vol. 27 N.º 6 (2014): Novembro-Dezembro; 685-691 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799130641506238464 |