Department of General Surgery, Golbasi State Hospital, Adıyaman-Türkiye.
University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, General Surgery Clinic, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Jul;29(7):772-779. doi: 10.14744/tjtes.2023.54703.
Acute cholecystitis is one of the most common emergent surgeries. As a safe alternative in challenging operations, laparoscopic subtotal cholecystectomy (LSC) is widely used. We questioned whether the results in acute cholecystitis cases changed with a history of endoscopic retrograde cholangiopancreatography (ERCP). When we searched the literature, we could not find a study focusing on the subtotal cholestectomy results in acute cholecystitis. In our study, we aimed to investigate whether the history of ERCP affects the rates of subtotal cholecystectomy (SC) in acute cholecystitis.
The results of patients (n=470) who underwent surgery for acute cholecystitis at our clinic between 2016 and 2019 were retrospectively evaluated. The patients were divided into two groups according to their history of ERCP. The primary outcome was the SC rate. The secondary outcomes were conversion to open, postoperative complications, serious complications, operative duration, and length of hospital stay.
The standard group included 437 patients, whereas the ERCP group included 33 patients. A total of 16 patients underwent SC, with 15 in the standard group and 1 in the ERCP group. There was no significant difference in terms of SC rates between groups (P=0.902). While four cases of operation were completed with conversion to open in the non-ERCP group, no conversion was seen in the ERCP group (P=0.581). No significant differences were detected between the groups in terms of complications, serious compli-cations, operation duration, length of hospital stay, and mortality.
The results of this study showed that ERCP is not related to an increased rate of SC and conversion in patients with acute cholecystitis. Laparoscopic cholecystectomy for acute cholecystitis can be safely performed in patients with a history of ERCP. LSC is a safe procedure in challenging patients, and fenestrating SC can be preferred to avoid hazardous consequences in such cases.
急性胆囊炎是最常见的急诊手术之一。作为一种在复杂手术中安全的替代方案，腹腔镜胆囊次全切除术（LSC）被广泛应用。我们质疑在有内镜逆行胰胆管造影术（ERCP）史的情况下，急性胆囊炎患者的手术结果是否会发生变化。当我们在文献中搜索时，我们没有找到一项专门针对急性胆囊炎患者次全胆囊切除术结果的研究。在我们的研究中，我们旨在探讨 ERCP 史是否会影响急性胆囊炎患者次全胆囊切除术（SC）的发生率。
回顾性分析 2016 年至 2019 年在我院行手术治疗的 470 例急性胆囊炎患者的临床资料。根据 ERCP 史将患者分为两组。主要结局为 SC 率。次要结局为中转开腹率、术后并发症发生率、严重并发症发生率、手术时间和住院时间。
标准组 437 例，ERCP 组 33 例。共有 16 例患者行 SC，其中标准组 15 例，ERCP 组 1 例。两组 SC 率无显著差异（P=0.902）。非 ERCP 组有 4 例手术转为开腹，ERCP 组无中转开腹（P=0.581）。两组在并发症发生率、严重并发症发生率、手术时间、住院时间和死亡率方面无显著差异。
本研究结果表明，ERCP 与急性胆囊炎患者 SC 率和中转开腹率的增加无关。对于有 ERCP 史的急性胆囊炎患者，腹腔镜胆囊切除术是安全的。LSC 是一种安全的方法，对于有挑战性的患者，可以选择开窗 SC 以避免在这种情况下出现危险的后果。
