Laparoscopic Cholecystectomy Surgery in Cholecystitis

 



Overview

Acute cholecystitis is an inflammatory disease of the gallbladder, generally attributable to stones, however, it has been associated with other causes such as ischemia, motility disorders, direct injury, infection by microorganisms or parasites, collagen diseases, and allergic reactions. In most patients, the cause of this inflammation is the obstruction of the neck of the gallbladder or the cystic duct, which generates an increase in intravesicular pressure.

For a large number of reasons use of simulators is a prudent choice like Lap Endo Trainer.

Depending on the degree of obstruction (complete or partial) and its duration, the severity and prognosis of the disease is determined. Between 3.2% and 12% of patients with cholelithiasis develop cholecystitis, associated with an annual risk of to 3% 1. 26% of patients with cholelithiasis are admitted to the emergency department for acute cholecystitis.

In the International Consensus, acute cholecystitis was classified as mild, moderate and severe, according to the degree of inflammation and the presence of organ dysfunction, with a proportion of severe acute cholecystitis of 0.6% and total mortality 0.6%. According to this classification, the treatment to be followed is determined. Male sex has been shown to be a risk factor for severe gallbladder inflammation and, therefore, earlier intervention may be necessary to reduce the risk of complications.

Treatment of Choice

There is a classification of acute cholecystitis in three stages, according to the time of evolution after the onset of symptoms: acute, less than 7hours; subacute, from 7hours to 1days, and chronic, more than 1days.

Due to the risk of biliary complications, such as pancreatitis or choledocholithiasis, progression to more serious stages of the disease and recurrence of symptoms, the treatment of choice for acute cholecystitis is cholecystectomy, whether it is timely depends on the severity of the disease. acute cholecystitis. Therefore, in mild to moderate acute cholecystitis, early cholecystectomy is recommended (within 7hours of symptom onset) and, in severe acute cholecystitis, the choice is delayed cholecystectomy more drainage vesicular.

Laparoscopic cholecystectomy is the surgical approach of choice for the management of acute cholecystitis; 20% of laparoscopic cholecystectomies are performed under this indication. However, it should be taken into account that, in the presence of acute inflammation, the surgical procedure is more difficult and, therefore, the rate of complications and conversion to open surgery is higher.

This is due to edema, adhesions to other structures or organs, gallbladder distention, tissue friability, distortion of the hepatic biliary and vascular anatomy, increased blood supply, and congestion. For this reason, some controversy has arisen regarding the optimal time to perform laparoscopic cholecystectomy in patients with acute and subacute cholecystitis.

Beginning of Symptoms

In cases of acute cholecystitis, multiple studies, among other randomized studies and meta-analyzes, show that early laparoscopic cholecystectomy is safe, preferably in the first 2hours after the beginning of symptoms. This is associated with a shorter hospital stay, less blood loss, fewer complications and fewer conversions to open surgery, in addition to greater economic benefit and less surgical difficulty compared to delayed or interval cholecystectomy. The latter approach consists of performing laparoscopic cholecystectomy between the sixth and twelfth week of the acute episode.

However, doing so is associated with failures in conservative management in 26% of patients, requiring urgent surgical intervention before the previously stipulated time. furthermore, 28.5% of these were hospitalized again for complications such as cholangitis, pancreatitis, or gallbladder perforation, before the time for interval cholecystectomy was reached.

Safety of Laparoscopic Cholecystectomy

There are some studies in which the results are compared between patients operated on in the subacute period of the disease and others operated on in the acute phase, and the safety of laparoscopic cholecystectomy is confirmed after 7hours of onset of symptoms, without any demonstrate statistically significant differences in conversion rates, surgical time, postoperative hospital stay, or mortality

Due to the lack of specific studies published in our setting that include only cases of subacute cholecystitis (more than 7hours after the onset of symptoms), the objective of this study was to describe the results of laparoscopic cholecystectomy in this group of patients, in which is presumed that the inflammatory process is greater.

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