Rao Varun, DeLeon Genaro, Becker Timothy, Duggan Benjamin, Pei Kevin Y
Indiana University School of Medicine, 340W 10th St, Indianapolis, IN 46202, USA.
Parkview Health Graduate Medical Education, 2200 Randallia Dr., Fort Wayne, IN 46805, USA.
Surg Pract Sci. 2023 Jul 17;14:100203. doi: 10.1016/j.sipas.2023.100203. eCollection 2023 Sep.
Gallstone ileus is an uncommon etiology of intestinal obstruction, although many cases require surgical repair. There is no consensus regarding the necessity of concomitant cholecystectomy. (CCY) at the time of index surgery. This study aimed to evaluate the outcomes of gallstone ileus in patients with and without CCY.
Using the ACS NSQIP database from 2005 to 2019, we included patients who underwent surgical management of gallstone ileus (enterolithotomy) with or without CCY. The primary outcomes of interest were surgical site infection (SSI) and 30-day mortality. Additional outcomes of interest included readmissions related to the procedure, length of hospital stay (LOS), return to the operating room, and sepsis. Demographics were evaluated using univariate analysis, whereas outcomes of interest were analyzed using multivariate logistic regression.
A total of 825 cases of gallstone ileus were identified among 118 patients who underwent cholecystectomy. Patient characteristics were similar between the groups. No concomitant cholecystectomy was associated with a longer hospital stay (8 days vs. five days, <0.01) and tended to be more likely to return to the operating room (45 cases vs. 4 cases, = 0.08), but this was not statistically significant. No concomitant CCY was associated with increased SSI rates, readmissions related to the procedure, 30-day mortality, or sepsis.
Surgical management of gallstone ileus with or without CCY has similar short-term postoperative outcomes.
胆石性肠梗阻是肠梗阻的一种罕见病因，尽管许多病例需要手术修复。对于初次手术时是否有必要同时行胆囊切除术（CCY），目前尚无共识。本研究旨在评估行与未行CCY的胆石性肠梗阻患者的治疗结果。
利用2005年至2019年的美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库，我们纳入了接受胆石性肠梗阻手术治疗（取石术）且行或未行CCY的患者。主要关注的结局是手术部位感染（SSI）和30天死亡率。其他关注的结局包括与手术相关的再入院、住院时间（LOS）、返回手术室以及脓毒症。使用单因素分析评估人口统计学特征，而使用多因素逻辑回归分析关注的结局。
在118例行胆囊切除术的患者中，共识别出825例胆石性肠梗阻病例。两组患者的特征相似。未同时行胆囊切除术与住院时间较长（8天对5天，<0.01）相关，且返回手术室的可能性更大（45例对4例，P = 0.08），但这无统计学意义。未同时行CCY与SSI发生率增加、与手术相关的再入院、30天死亡率或脓毒症无关。
行或未行CCY的胆石性肠梗阻手术治疗具有相似的术后短期结局。
