Retrospective Analysis Laparoscopic Cholecystectomy in Cholecystitis

 

Materials and Methods

An observational and descriptive study was carried out, with retrospective data collection in the IPS, a institution of the fourth level of complexity.

Patients 1years of age or older with subacute calculous cholecystopathy, who underwent laparoscopic cholecystectomy between January and December 2014, were included. Patients with operative findings or subsequent diagnosis of malignancy in the gallbladder, with cholangitis or with pancreatitis, and those whose medical history did not have complete information on the outcomes of interest. The severity of the disease was not classified in the included patients.

Simulations of laparoscopy is significant choice Laparoscopic Endo Trainer.

Prior approval of the Health Research Ethics Committee and with institutional endorsement, the surgery database was reviewed to identify.

Two investigators reviewed the eligibility criteria in the medical records and recorded the following variables in a computerized database: demographic data (age, sex, social security, and place of residence), comorbidities (type diabetes, chronic kidney disease, and immunosuppression ), laboratory tests at the time of the intervention (C-reactive protein and number of leukocytes), previous episodes of biliary colic and duration of symptoms before admission to the institution; It was not possible to obtain variables such as weight and height, due to the lack of recording of these data in the clinical history.

Laparoscopic Cholecystectomy Procedures

Regarding the procedure, its duration, operative findings, the need for drainage, the need for cholangiography, and the conversion rate to open surgery were considered. Complications related to the procedure were: biliary fistula, bleeding, infection of the surgical site, reoperation or injury to the bile duct; Furthermore, readmission before 3 days after hospital discharge, mortality, hospital stay and the need for intensive care unit care were considered.

The frequencies of the qualitative variables were described. Continuous variables were expressed as mean with their standard deviation or as medians with their interquartile range (IQR), according to the distribution of the variable assessed with the Kolmogórov-Smirnov test. No comparisons were made to use statistical tests of hypotheses.

Effects

During the study period, 45laparoscopic cholecystectomies for any cause were identified, and 18(41%) were selected that met the inclusion criteria. In most of the patients not included, their exclusion was due to the fact that laparoscopic cholecystectomy was performed in the acute phase or without an associated inflammatory process.

The patients operated had a mean age of 5years (standard deviation, SD = 19.3), and 61.4% were women. 21% of the patients were linked to the subsidized regime social security system, and the distribution between rural and urban origin was similar.

The most frequent comorbidities were type diabetes (20.1%), chronic kidney disease (10.3%), and immunosuppression (1.6%). The duration of symptoms before the emergency visit averaged four days. In 34.2% of the cases there was a history of biliary colic before hospitalization.

Assessments

In the initial laboratory tests taken in the emergency department, the average C-reactive protein was 10.mg / dl and the number of leukocytes was 12,51per mm (Table 1).

Table 1.  Demographic and clinical characteristics of patients with subacute cholecystitis (N = 184)

A history of at least one previous abdominal surgery was found in 5(31%) patients, and among these, the majority (91%) corresponded to open procedures located in the lower hemiabdomen.

The mean surgical time for laparoscopic cholecystectomy was 9 minutes (SD = 35.minutes). 89% of these procedures were performed during the day.

Surgical bleeding occurred in 3(16%) patients, there was a need to leave drains in 4(26%), the reoperation rate was 1.6%. Two operative cholangiographies and seven (3.8%) subtotal cholecystectomies were performed, and 2(13%) patients required conversion to open cholecystectomy. The most common surgical findings were: gallbladder plastron (24%), pyocholecyst (21%), and gallbladder necrosis (16.8%); and gallbladder perforation was found only in 6.5% of the patients (Table 2).

Table 2.  Characteristics of laparoscopic cholecystectomy in patients with subacute cholecystitis (N = 184)

The postoperative complication rate was 8.15%, corresponding to: surgical site infection, superficial in two (1.1%) and organ or space in two (1.1%); Biliary fistula in five (2.7%) and bile duct injury in one (0.5%) (Table 3).

Table 3.  Complications of laparoscopic cholecystectomy in patients with subacute cholecystitis (N = 184)

Of the total of 18 patients, 2(12%) required care in the intermediate or intensive care units: one patient (0.54%) due to postoperative hemoperitoneum, four (2.1%) due to septic shock and the other 1(, 7%) due to decompensation of its underlying comorbidities or due to acute processes other than cholecystitis.

A mortality rate of 1.1% was presented, corresponding to two deceased patients, one due to cardiorespiratory arrest during surgery and the other due to resistant biliary sepsis.

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