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Surgical management of acute cholecystitis: Results of a 2-year prospective multicenter survey in Belgium
Authors
Donald Claeys
Jean Closset
+15 more
Bernard Detroz
Olivier Detry
Bart Devos
Jean-François Gigot
Catherine Hubert
Marc Kint
Martens Michiels
Filip Muysoms
Benoît Navez
Julie Navez
The Belgian Group for Endoscopic Surgery (BGES)
The Hepatobiliary and Pancreatic Section (HBPS) of the Royal Belgian Society of Surgery
Felicia Ungureanu
Marc Vanderveken
Francis Zech
Publication date
1 January 2012
Publisher
'Springer Science and Business Media LLC'
Doi
Cite
Abstract
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
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