Ugarte Chaiss, Ugarte Ramsey, Gallagher Shea, Park Stephen, Kagan Odeya, Murphy Ryan, Matsushima Kazuhide, Inaba Kenji, Martin Matthew J, Schellenberg Morgan
Division of Acute Care Surgery, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA.
Division of Acute Care Surgery, Harbor UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, USA.
Am Surg. 2025 Apr;91(4):505-511. doi: 10.1177/00031348241304008. Epub 2024 Nov 28.
BackgroundFor difficult cholecystectomies, bail out procedures (BOP) are performed to mitigate risk of patient harm.ObjectiveThis study sought to identify risk factors for BOP for acute cholecystitis and to compare outcomes by type of BOP performed. Patients with acute cholecystitis who underwent cholecystectomy were included (2020-2022). Demographics, clinical data, and outcomes were collected. Primary outcome was <30-day complication rate. Groups were defined by surgery performed: BOP vs Laparoscopic Complete Cholecystectomy (LCC). BOPs were defined as any deviation from laparoscopic complete cholecystectomy. Univariate analyses compared outcomes between groups. Multivariable analysis identified independent factors associated with BOP. Subgroup analysis compared outcomes of laparoscopic BOP vs open BOP.ResultsOf 728 patients, 659 (91%) underwent LCC and 69 (9%) underwent BOP: 34 (49%) laparoscopic BOP and 35 (51%) open BOP. Independent predictors of BOP included admission total bilirubin >0.2 mg/dL (OR 5.80, = .017), >7 days of symptoms at time of cholecystectomy (OR 1.96, = .019), and arrival heart rate >100 bpm (OR 1.82, = .032). On subgroup analysis, laparoscopic vs open BOP demonstrated no difference in operative time ( = .536) and overall ( = .733) or gallbladder-related complications ( = .364), including bile leaks ( = .090). Laparoscopic BOP was associated with shorter postoperative lengths of stay ( = .005).ConclusionThe risk factors for BOP identified in this study may help inform patient consent and operative planning. Laparoscopic BOP incurred equivalent complications to open BOP but with shorter hospital stays, challenging conventional dogma that conversion to open is the optimal approach for complicated acute cholecystitis.
背景
对于困难的胆囊切除术，采用挽救性手术（BOP）以降低患者受到伤害的风险。
目的
本研究旨在确定急性胆囊炎行BOP的危险因素，并比较不同类型BOP的手术结果。纳入2020年至2022年期间接受胆囊切除术的急性胆囊炎患者。收集人口统计学、临床数据和手术结果。主要结局为30天内并发症发生率。根据所实施的手术方式将患者分为两组：BOP组与腹腔镜完全胆囊切除术（LCC）组。BOP定义为与腹腔镜完全胆囊切除术的任何偏差。单因素分析比较两组间的手术结果。多变量分析确定与BOP相关的独立因素。亚组分析比较腹腔镜BOP与开腹BOP的手术结果。
结果
728例患者中，659例（91%）接受了LCC，69例（9%）接受了BOP：34例（49%）为腹腔镜BOP，35例（51%）为开腹BOP。BOP的独立预测因素包括入院时总胆红素>0.2mg/dL（OR 5.80，P = .017）、胆囊切除时症状持续>7天（OR 1.96，P = .019）以及入院时心率>100次/分（OR 1.82，P = .032）。亚组分析显示，腹腔镜BOP与开腹BOP在手术时间（P = .536）、总体（P = .733）或胆囊相关并发症（P = .364）方面无差异，包括胆漏（P = .090）。腹腔镜BOP与术后住院时间缩短相关（P = .005）。
结论
本研究确定的BOP危险因素可能有助于患者知情同意和手术规划。腹腔镜BOP与开腹BOP的并发症相当，但住院时间更短，这对传统观念中对于复杂急性胆囊炎转为开腹手术是最佳方法提出了挑战。
