Pesce Antonio, Ramírez-Giraldo Camilo
Department of Surgery, Azienda Unità Sanitaria Locale Ferrara, University of Ferrara, Via Valle Oppio, 2 - 44023, Lagosanto, FE, Italy.
Hospital Universitario Mayor - Méderi, Calle 24 #29 - 45, Bogotá, Colombia.
Surg Endosc. 2025 Jan;39(1):14-15. doi: 10.1007/s00464-024-11432-3. Epub 2024 Dec 10.
Laparoscopic cholecystectomy is the gold standard for managing acute cholecystitis. However, in high-risk surgical patients, percutaneous cholecystostomy is frequently used either as a bridge to surgery or as definitive treatment. When employed as a bridge to surgery, the optimal timing for laparoscopic cholecystectomy after cholecystostomy remains unclear.
A critical review of the literature was conducted, focusing particularly on the article published by Spaniolas, et al., presented at SAGES 2024, to evaluate the optimal timing for performing laparoscopic cholecystectomy after a cholecystostomy, according to the available evidence.
The available literature was found to be limited. The timing thresholds vary across studies, preventing a pooled evaluation of the effect size. The study by Spaniolas, et al. has several limitations, including the exclusion of subtotal cholecystectomies from the composite endpoint and the introduction of implausible variables in the logistic regression model.
Ideally, the procedure should be performed when it is least technically demanding, minimizing the need for rescue procedures (such as subtotal cholecystectomy, antegrade cholecystectomy, or conversion to open surgery) and reducing complications. This topic is increasingly relevant in clinical practice. However, the current scientific evidence remains limited.
腹腔镜胆囊切除术是治疗急性胆囊炎的金标准。然而，在高风险手术患者中，经皮胆囊造瘘术常被用作手术桥梁或确定性治疗方法。当用作手术桥梁时，胆囊造瘘术后腹腔镜胆囊切除术的最佳时机仍不明确。
对文献进行了批判性综述，特别关注西班牙奥拉等人在2024年SAGES会议上发表的文章，根据现有证据评估胆囊造瘘术后进行腹腔镜胆囊切除术的最佳时机。
发现现有文献有限。各研究的时间阈值不同，无法对效应量进行汇总评估。西班牙奥拉等人的研究有几个局限性，包括在复合终点中排除了胆囊次全切除术，以及在逻辑回归模型中引入了不合理的变量。
理想情况下，该手术应在技术要求最低时进行，尽量减少补救手术（如胆囊次全切除术、顺行胆囊切除术或转为开放手术）的需求并减少并发症。这个话题在临床实践中越来越重要。然而，目前的科学证据仍然有限。
