Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013 View Full Text


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Article Info

DATE

2017-11-28

AUTHORS

Koetsu Inoue, Tatsuya Ueno, Daisuke Douchi, Kentaro Shima, Shinji Goto, Michinaga Takahashi, Takanori Morikawa, Takeshi Naitoh, Chikashi Shibata, Hiroo Naito

ABSTRACT

BackgroundThe Tokyo Guidelines 2013 classifies acute cholecystitis (AC) into three grades and recommends appropriate therapy for each grade. For grade II AC, either early laparoscopic cholecystectomy (LC) or percutaneous transhepatic gallbladder drainage (PTGBD) should be performed. This study aimed to identify the risk factors for difficulty of LC for treating grade II AC.MethodsTotally, 122 patients who underwent LC for grade II AC were enrolled and divided into difficult LC (DLC) and nondifficult LC (NDLC) groups. The DLC group included patients who experienced one of the following conditions: conversion from LC to open cholecystectomy, operating time ≥ 180 min, or blood loss ≥300 ml. Preoperative characteristics and postoperative outcomes were analyzed.ResultsIn univariate analysis, risk factors included male sex, interval between symptom onset and admission, interval between symptom onset and LC, and anticoagulant therapy. The incidence of postoperative complications was higher in the DLC group than in the NDLC group (23.5% vs. 4.6%, p = 0.0016). According to receiver operating characteristic curves, the optimal cutoff value was calculated, and multivariate analysis showed that male sex [odds ratio (OR), 5.76; 95% confidence interval (CI), 1.979–19.51; p = 0.0009) and interval between symptom onset and LC of over 96 h (OR, 6.32; 95% CI, 2.126–20.15; p = 0.0009) were independent risk factors for difficulty of LC.ConclusionsIn patients with grade II AC, LC was technically difficult when performed over 96 h after symptom onset. Moreover, male sex was a risk factor. Therefore, PTGBD should be considered in these patients. More... »

PAGES

114

References to SciGraph publications

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    http://scigraph.springernature.com/pub.10.1186/s12893-017-0319-6

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    http://dx.doi.org/10.1186/s12893-017-0319-6

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    https://app.dimensions.ai/details/publication/pub.1093060425

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29183352


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    31 schema:description BackgroundThe Tokyo Guidelines 2013 classifies acute cholecystitis (AC) into three grades and recommends appropriate therapy for each grade. For grade II AC, either early laparoscopic cholecystectomy (LC) or percutaneous transhepatic gallbladder drainage (PTGBD) should be performed. This study aimed to identify the risk factors for difficulty of LC for treating grade II AC.MethodsTotally, 122 patients who underwent LC for grade II AC were enrolled and divided into difficult LC (DLC) and nondifficult LC (NDLC) groups. The DLC group included patients who experienced one of the following conditions: conversion from LC to open cholecystectomy, operating time ≥ 180 min, or blood loss ≥300 ml. Preoperative characteristics and postoperative outcomes were analyzed.ResultsIn univariate analysis, risk factors included male sex, interval between symptom onset and admission, interval between symptom onset and LC, and anticoagulant therapy. The incidence of postoperative complications was higher in the DLC group than in the NDLC group (23.5% vs. 4.6%, p = 0.0016). According to receiver operating characteristic curves, the optimal cutoff value was calculated, and multivariate analysis showed that male sex [odds ratio (OR), 5.76; 95% confidence interval (CI), 1.979–19.51; p = 0.0009) and interval between symptom onset and LC of over 96 h (OR, 6.32; 95% CI, 2.126–20.15; p = 0.0009) were independent risk factors for difficulty of LC.ConclusionsIn patients with grade II AC, LC was technically difficult when performed over 96 h after symptom onset. Moreover, male sex was a risk factor. Therefore, PTGBD should be considered in these patients.
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    38 schema:keywords ConclusionsIn patients
    39 DLC group
    40 LC group
    41 MethodsTotally
    42 ResultsIn univariate analysis
    43 Tokyo Guidelines 2013
    44 acute cholecystitis
    45 admission
    46 analysis
    47 anticoagulant therapy
    48 appropriate therapy
    49 blood loss
    50 characteristic curve
    51 characteristics
    52 cholecystectomy
    53 cholecystitis
    54 complications
    55 conditions
    56 conversion
    57 curves
    58 cutoff value
    59 difficult LC
    60 difficult laparoscopic cholecystectomy
    61 difficulties
    62 difficulty of LC
    63 drainage
    64 early laparoscopic cholecystectomy
    65 factors
    66 gallbladder drainage
    67 grade
    68 grade II acute cholecystitis
    69 group
    70 incidence
    71 independent risk factor
    72 interval
    73 laparoscopic cholecystectomy
    74 loss
    75 male sex
    76 min
    77 multivariate analysis
    78 onset
    79 optimal cutoff value
    80 outcomes
    81 patients
    82 percutaneous transhepatic gallbladder drainage
    83 postoperative complications
    84 postoperative outcomes
    85 preoperative characteristics
    86 receiver
    87 risk factors
    88 sex
    89 study
    90 symptom onset
    91 therapy
    92 time
    93 univariate analysis
    94 values
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