Impact of cardiovascular/diabetic comorbidity on conversion rate during laparoscopic cholecystectomy for acute cholecystitis: a multi-center study on early versus very delayed approach.

IF 0.4 Q4 SURGERY

Giornale di Chirurgia Pub Date : 2019-03-01

A Lauro, M Cervellera, V D'Andrea, Giuseppina Casella, F M Di Matteo, F M Di Matteo, A Santoro, A Panarese, G Palazzini, R Cirocchi, E Agastra, L Falvo, E Talarico, S Cicia, V Tonini

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引用次数: 0

Abstract

Background: The impact of diabetes and cardiovascular comorbidity on laparoscopic cholecystectomy has been long debated, evaluating them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an "early" procedure, as suggested by 2013 Tokyo guidelines, has been compared to a "very delayed" one in patients under anticoagulant/antiplatelet therapy or treated for diabetes and referred by medical wards to surgery after the acute period.

Methods: We selected 240 patients operated for acute cholecystitis by laparoscopy over the last 4 years at St. Orsola University Hospital-Bologna and Umberto I University Hospital-Rome, comparing 98 diabetic/cardiovascular patients versus 142 subjects as control group: the selection was based on operative timing, "early" (73 patients treated within 3 days) and "very delayed" (167 patients operated after 6 weeks).

Results: In the "early" subgroup there was no difference comparing diabetic/cardiovascular patients (31 pts) versus control group (42 pts) while in the "very delayed" subgroup among diabetic/cardiovascular patients (67 pts) there was significantly male predominance, ASA III/IV prevalence and less positive imaging findings versus control group (100 pts). In both subgroups, the conversion rate was significantly higher for diabetic/cardiovascular patients ("early"=25.8% and "very delayed"=8.95%) compared to control groups ("early"=4.76% and "very delayed"=1%), showing a trend (p=0.058) towards an increased conversion rate in the early approach among diabetic/cardiovascular group.

Conclusions: Our study showed a significantly increased conversion rate to an open cholecystectomy for diabetic/cardiovascular patients affected by cholecystitis, especially within 3 days by the acute episode.

本刊更多论文

心血管/糖尿病合并症对急性胆囊炎腹腔镜胆囊切除术转换率的影响:早期与非常延迟入路的多中心研究

背景:糖尿病和心血管合并症对腹腔镜胆囊切除术的影响一直存在争议，评估它们是否为转换为开放式手术的危险因素，特别是在急性胆囊炎患者中:2013年东京指南建议的“早期”手术与“非常延迟”手术相比，在接受抗凝血/抗血小板治疗或接受糖尿病治疗的患者中，急性期后由医院转介到手术。方法:选取近4年来在博洛尼亚圣奥索拉大学医院和罗马翁贝托第一大学医院行腹腔镜手术的急性胆囊炎患者240例，比较98例糖尿病/心血管患者和142例对照组。选择依据手术时间，“早期”(73例在3天内治疗)和“非常延迟”(167例在6周后手术)。结果:在“早期”亚组中，糖尿病/心血管患者(31例)与对照组(42例)相比没有差异，而在“非常延迟”亚组中，糖尿病/心血管患者(67例)中有明显的男性优势，ASA III/IV患病率，与对照组(100例)相比，阳性影像学结果较少。在这两个亚组中，糖尿病/心血管患者的转换率(“早期”=25.8%，“非常延迟”=8.95%)明显高于对照组(“早期”=4.76%，“非常延迟”=1%)，显示出糖尿病/心血管患者早期转换率增加的趋势(p=0.058)。结论:我们的研究显示，糖尿病/心血管患者并发胆囊炎的转换率显著增加，特别是急性发作后3天内。

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来源期刊

Giornale di Chirurgia SURGERY-

CiteScore

1.10

自引率

0.00%

发文量

期刊介绍： Il Giornale di Chirurgia pubblica contributi che propongono le diverse tecniche su patologia chirurgiche di attualità. Pubblica articoli originali, casistica clinica, metodi, tecniche, terapia farmacologica pre-operatoria e post-chirurgica, ed articoli inerenti la descrizione di tecniche chirurgiche.