Surgical management of acute cholecystitis: Results of a 2-year prospective multicenter survey in Belgium

Background: Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking. Methods: A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients' clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis. Results: Fifty-three surgeons consecutively and anonymously included 1,089 patients in this prospective study. A primary open approach was chosen in 74 patients (6.8%), whereas a laparoscopic approach was the first option in 1,015 patients (93.2%). Independent predictive factors for a primary open approach were previous history of upper abdominal surgery [odds ratio (OR) 4.13, p < 0.001], patient age greater than 70 years (OR 2.41, p < 0.05), surgeon with more than 10 years' experience (OR 2.08, p = 0.005), and gangrenous cholecystitis (OR 1.71, p < 0.05). In the laparoscopy group, 116 patients (11.4%) required conversion to laparotomy. Overall, 38 patients (3.5%) presented biliary complications and 49 had other local complications (4.5%). Incidence of bile duct injury was 1.2% in the whole series, 2.7% in the open group, and 1.1% in the laparoscopy group. Sixty patients had general complications (5.5%). The overall mortality rate was 0.8%. All patients who died were in poor general condition [American Society of Anesthesiologists (ASA) III or IV]. Conclusions: Although laparoscopic cholecystectomy is currently considered as the standard treatment for acute cholecystitis, an open approach is still a valid option in more advanced disease. However, overall mortality and incidence of bile duct injury remain high. © 2012 Springer Science+Business Media, LLC.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Influence of aberrant right hepatic artery on perioperative course and longterm survival after pancreatoduodenectomy

Objectives: An aberrant right hepatic artery (aRHA) is the most frequently encountered vascular anomaly during pancreatoduodenectomy (PD). This study was performed to investigate the incidence of aRHA in a large series of PDs and to explore its relationship with complications and survival. Methods: In a consecutive series of 790 PDs, aRHA could be identified or ruled out in 758 patients by reviewing operation reports. Patients with and without aRHA were compared. Main outcome measures were complications and survival (only in patients with a malignancy). Results: The aRHA group consisted of 143 patients (19%). Characteristics of patients in the aRHA and normal RHA groups were comparable. There were no differences in surgical complications. The aRHA was preserved without damage in 130 patients (91%). Two patients in whom the aRHA was either sacrificed or damaged suffered complications (haemorrhage and intra-abdominal abscess in the right upper quadrant) that may have been related. Longterm survival in patients with a malignancy and an aRHA was not compromised. Conclusions: An aRHA is frequently encountered during PD. Preservation is generally feasible without compromising survival in patients with malignant tumours. Surgical morbidity is not higher in patients with an aRHA. Preservation is technically possible in most patients and does not negatively impact on outcome