scholarly journals Laparoscopic Cholecystectomy in High Risk Patients

10.5772/18745 ◽  
2011 ◽  
Author(s):  
Abdulrahman Saleh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Michele Pisano ◽  
Niccolò Allievi ◽  
Kurinchi Gurusamy ◽  
Giuseppe Borzellino ◽  
Stefania Cimbanassi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
Emergency Surgery ◽  
Task Force ◽  
World Society ◽  
Online Questionnaire ◽  
High Risk Patients ◽  
Risk Patients ◽  
Key Questions

Abstract Background Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. Materials and methods The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. Results The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. Conclusions, knowledge gaps and research recommendations ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.

scholarly journals A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

2013 ◽  
Vol 95 (5) ◽  
pp. 345-348 ◽  
Author(s):  
F Yanni ◽  
P Mekhail ◽  
G Morris-Stiff
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Gallstone Disease ◽  
Anaerobic Growth ◽  
Current Evidence ◽  
High Risk Patients ◽  
Risk Patients

Introduction It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors: acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. Current evidence-based guidance on antibiotic prophylaxis during laparoscopic cholecystectomy (LC) is based on elective procedures and does not take into account these factors. The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint. Methods One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospectively. Data collected included patient demographics (age, sex) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia. A single dose of antibiotics (second generation cephalosporin and metronidazole) was administered on induction to patients with a risk factor present. Information relating to all radiologically or microbiologically confirmed infections was documented. Results Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years. Nineteen LCs were performed as emergencies and the remainder were elective procedures. A risk factor for bactibilia was present in 35 patients. A wound infection was identified in four cases, two of which were Staphylococcus aureus (one methicillin resistant), one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth. Three of the infections occurred in patients receiving prophylaxis (2 staphylococcal and 1 anaerobic) at intervals of 7, 14 and 19 days respectively. One patient with a body mass index of 32kg/m2 in the ‘no prophylaxis’ group developed a coagulase negative staphylococcal infection at 10 days. No intra or extra-abdominal abdominal infections were identified. Conclusions This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors. Furthermore, the act of not prescribing to low risk patients will limit costs and the risk of adverse events. It will also reduce the risk of resistance and clostridial infections in this cohort.

scholarly journals Treatment of gallstones in high-risk patients using laparoscopic cholecystectomy: Analysis of 93 cases

2013 ◽  
Vol 21 (26) ◽  
pp. 2734
Author(s):  
Zhi-Fang Cai ◽  
Dan-Hua Dui ◽  
Tian-Gang Lan ◽  
Yao Liu ◽  
Hui Huang
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients
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