Öz
Aim. Laparoscopic cholecystectomy is the gold standard method in the treatment of elective symptomatic gallstones. In acute cholecystitis, the rate of conversion to an open procedure is 1525% higher when compared to elective cases. In this study we aimed to evaluate the effectiveness of patients’ preoperative features, as these may affect the decision to convert to open surgery. Methods. This single-center study was conducted between June 2007-2009 with 122 patients who were treated for acute cholecystitis. The primary objective was to define the criterias for C-reactive protein, erythrocyte sedimentation rate, white blood count, gender and age for conversion to open procedure. Results. A total of 102 patients were included in the study. Laparoscopic cholecystectomy was successfully performed in 75 patients; and open conversion was required in 27 patients. The analysis showed that male gender, erythrocyte sedimentation rate and C-reactive protein levels, and severe ultrasonographic findings of acute cholecystitis in the conversion group were significantly different than in the laparoscopy group and these parameters were independent predictive factors of conversion. Conclusion. Male gender, high erythrocyte sedimentation rate and C-reactive protein levels and severe ultrasonographic findings are predictive actors which may help facilitate a conversion to open surgery.
Anahtar Kelimeler
Acute cholecystitis laparoscopic cholecystectomy C-reactive protein erythrocyte sedimentation rate
Kaynakça
- Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: Is it really safe? World J Surg 1996; 20: 43Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 1997; 184: 571-8.
- Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 1993; 218: 630Zucker KA, Flowers JL, Bailey RW, Graham SM, Buell J, Imbembo AL. Laparoscopic management of acute cholecystitis. Am J Surg 1993; 165: 508-14. Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A. Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 1996; 10: 1045-9. van der Steeg HJ, Alexander S, Houterman S, Slooter GD, Roumen RM. Risk factors for conversion during laparoscopic cholecystectomy - experiences from a general teaching hospital. Scand J Surg 2011; 100: 169-73.
- Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J. Hepatobiliary Pancreat Surg 2007; 14: 78-82.
- Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP. Laparoscopic cholescystectomy in acute cholecystitis. Laparoscopic cholecystectomy in acute cholecystitis. A prospective comparative study in patients with acute vs. chronic cholecystitis. Surg Endosc 2000; 14: 358-61.
- Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, Malangoni MA. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 2007; 142: 556-63.
- Schafer M, Krahenbühl L, Büchler MW. Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 2001; 182: 291-7.
- Jarvinen HJ, Hastbacka J. Early cholecystectomy for acute cholecystitis: A prospective randomized study. Ann Surg 1980; 191: 501-5.
- Lahtinen J, Alhava EM, Aukee S. Acute cholecystitis treated by early and delayed surgery. A controlled clinical trial. Scand J Gastroenterol 1978; 13: 673
- Zisman A, Gold-Deutch R, Zisman E, Negri M, Halpern Z, Lin G, Halevy A. Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy? Surg Endsoc 1996; 10: 892-4.
- Spira RM, Nissan A, Zamir O, Cohen T, Fields SI, Freund HR. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg 2002; 183: 62
- Borzellino G, Tasselli S, Zerman G, Castaldini G, de Manzoni G. Results of surgical treatment of acute cholecystitis. Prospective study of 280 cases. G Chir 2002; 23: 79-84.
- Grönroos JM, Grönroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg 1999; 86: 501-4.
- Chen CC, Wang SS, Lee FY, Chang FY, Lee SD. Proinflammatory cytokines in early assessment of the prognosis of acute pancreatitis. Am J Gastroenterol 1999; 94: 213-8.
- Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448-54.
- Mealy K, Gallagher H, Barry M, Lennon F, Traynor O, Hyland J. Physiological and metabolic responses to open and laparoscopic cholecystectomy. Br J Surg 1992; 79: 1061-4.
- Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002; 184: 254-8.
- Daradkeh SS, Suwan Z, Abu-Khalaf M. Preoperative ultrasonography and prediction of technical difficulties during laparoscopic cholecystectomy. World J Surg 1998; 22: 75-7.
- Yetkin G, Uludag M, Citgez B, Akgun I, Karakoc S. Predictive factors for conversion of laparoscopic cholecystectomy in patients with acute cholecystitis. Bratisl Lek Listy 2009; 110: 688-91.
Öz
Amaç. Laparaskopik kolesistektomi, semptomatik safra taşlarının elektif tedavisinde altın standarttır. Akut kolesistitte elektif vakalara göre açık cerrahiye geçiş oranı %15-25 daha fazladır. Bu çalışmada açık cerrahiye geçiş kararını etkileyebileceği düşünülen preopratif hasta özelliklerinin değerlendirilmesi amaçlanmıştır. Yöntemler. Bu tek merkezli çalışmada Haziran2007-2009 arası akut kolesistit nedeni ile tedavi gören 122 hasta ile çalışmaya başlandı. Çalışmadaki primer hedef C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH), beyaz küre sayımı, cinsiyet ve yaş için açık işleme geçişte kriterler belirlemekti. Bulgular. Çalışmaya toplam 102 hasta dahil edildi. 75 hastada başarılı bir şekilde laparaskopik kolesistektomi gerçekleştirildi ve 27 hastada açık cerrahiye geçildi. Analiz sonuçları erkek cinsiyet, ESH, CRP düzeyleri ve ağır ultrasonografik bulguların geçiş grubunda laparoskopi grubuna göre anlamlı derecede farklı olduğunu gösterdi ve bu parametrelerin geçiş için bağımsız prediktif faktörler oldukları görüldü. Sonuç. Erkek cinsiyet, yüksek ESH ve CRP düzeyleri ile ağır USG bulguları açık cerrahiye geçiş kararı vermede yardımcı olabilecek prediktif faktörlerdir.
Anahtar Kelimeler
Akut kolesistit laparoskopik kolesistektomi C-reaktif protein eritrosit sedimentasyon hızı
Kaynakça
- Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: Is it really safe? World J Surg 1996; 20: 43Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 1997; 184: 571-8.
- Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 1993; 218: 630Zucker KA, Flowers JL, Bailey RW, Graham SM, Buell J, Imbembo AL. Laparoscopic management of acute cholecystitis. Am J Surg 1993; 165: 508-14. Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A. Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 1996; 10: 1045-9. van der Steeg HJ, Alexander S, Houterman S, Slooter GD, Roumen RM. Risk factors for conversion during laparoscopic cholecystectomy - experiences from a general teaching hospital. Scand J Surg 2011; 100: 169-73.
- Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J. Hepatobiliary Pancreat Surg 2007; 14: 78-82.
- Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP. Laparoscopic cholescystectomy in acute cholecystitis. Laparoscopic cholecystectomy in acute cholecystitis. A prospective comparative study in patients with acute vs. chronic cholecystitis. Surg Endosc 2000; 14: 358-61.
- Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, Malangoni MA. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 2007; 142: 556-63.
- Schafer M, Krahenbühl L, Büchler MW. Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 2001; 182: 291-7.
- Jarvinen HJ, Hastbacka J. Early cholecystectomy for acute cholecystitis: A prospective randomized study. Ann Surg 1980; 191: 501-5.
- Lahtinen J, Alhava EM, Aukee S. Acute cholecystitis treated by early and delayed surgery. A controlled clinical trial. Scand J Gastroenterol 1978; 13: 673
- Zisman A, Gold-Deutch R, Zisman E, Negri M, Halpern Z, Lin G, Halevy A. Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy? Surg Endsoc 1996; 10: 892-4.
- Spira RM, Nissan A, Zamir O, Cohen T, Fields SI, Freund HR. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg 2002; 183: 62
- Borzellino G, Tasselli S, Zerman G, Castaldini G, de Manzoni G. Results of surgical treatment of acute cholecystitis. Prospective study of 280 cases. G Chir 2002; 23: 79-84.
- Grönroos JM, Grönroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg 1999; 86: 501-4.
- Chen CC, Wang SS, Lee FY, Chang FY, Lee SD. Proinflammatory cytokines in early assessment of the prognosis of acute pancreatitis. Am J Gastroenterol 1999; 94: 213-8.
- Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448-54.
- Mealy K, Gallagher H, Barry M, Lennon F, Traynor O, Hyland J. Physiological and metabolic responses to open and laparoscopic cholecystectomy. Br J Surg 1992; 79: 1061-4.
- Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002; 184: 254-8.
- Daradkeh SS, Suwan Z, Abu-Khalaf M. Preoperative ultrasonography and prediction of technical difficulties during laparoscopic cholecystectomy. World J Surg 1998; 22: 75-7.
- Yetkin G, Uludag M, Citgez B, Akgun I, Karakoc S. Predictive factors for conversion of laparoscopic cholecystectomy in patients with acute cholecystitis. Bratisl Lek Listy 2009; 110: 688-91.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Şubat 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 4 |