Verification of Our Therapeutic Criterion for Acute Cholecystitis : "Perform a Subemergency Laparoscopic Cholecystectomy when a Patient is Judged to be able to Tolerate General Anesthesia" - The Experience in a Single Community Hospital

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  • 急性胆囊炎に対する治療指針―全身麻酔可能と判断される場合には準緊急で腹腔鏡下胆囊摘出術を施行する―の検討

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Abstract

eng=Background : Our current therapeutic criterion for acute cholecystitis is : Perform a subemergency laparoscopic cholecystectomy (LC) when a patient is judged to be able to tolerate general anesthesia. The aim of the current study was to verify whether this criterion is justified. Methods : The outcomes of 21 cases of LC for acute cholecystitis performed between April 2011 and September 2013 were retrospectively analyzed. Subemergency LC was performed according to the aforementioned criterion (Subemergency group ; n = 16). Patient who was judged to be unable to tolerate general anesthesia underwent percutaneous transhepatic gallbladder drainage (PTGBD) first, then LC after the patients' condition became stable (PTGBD group ; n = 5). Results : There is no conversion to open surgery throughout the study period. The mean of the total hospital stays in the Subemergency group was significantly shorter than that in the PTGBD group (11.5 ± 5.3 vs. 30.4 ± 8.5 days). Although two patients in the Subemergency group, who had already needed oxygen administration preoperatively, suffered postoperative respiratory failure, they completely recovered. On the other hand, there is no postoperative complication in the PTGBD group. Discussion : Subemergency LC could be safely performed when surgeons as well as anesthesiologists judged a patient to be able to tolerate general anesthesia, which significantly shorten hospital stays compared to elective LC after PTGBD. However, elective LC after PTGBD is an absolutely safer therapeutic option in treating unstable patients.

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  • 福岡醫學雜誌

    福岡醫學雜誌 104 (10), 339-343, 2013-10-25

    Fukuoka Medical Association

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