The Importance of Surgical Timing in Acute Cholecystitis and Postoperative Intravenous Tramadol Consumption

Abstract

OBJECTIVE: Although laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis, its optimal timing remains controversial. In this study, our aim is to determine the appropriate cholecystectomy time by comparing the surgical results of emergency cholecystectomy with the cases of elective cholecystectomy applied to patients presenting with recurrent acute cholecystitis. METHODS: Data from 200 patients scheduled for cholecystectomy between January 1, 2020 and December 1, 2022 were used. All cases admitted to our hospital with recurrent cholecystitis attacks during the waiting period were evaluated retrospectively. Demographic data of the patients, stage of the disease, duration of hospital stay before and after surgery, duration of surgery, open surgery rate, use of drains, hollow organ injury, bile duct injury, bleeding, wound infection, postoperative collection aggregation, and death rates were analyzed. RESULTS: 80 (40%) of 200 patients who presented with recurrent cholecystitis underwent emergency LC (group 1), and 120 (60%) underwent elective LC (group 2). The preoperative hospital stay was significantly longer in group 2, and the mean surgery time was significantly longer in group 1 (p=0.001 and p=0.035, respectively). There was no significant difference between the groups in the rate of gastric or intestinal injury, biliary tract injury, wound infection and mortality. Open surgery and postoperative collection collection rates were compared between the two groups and no difference was found between the two groups. (p>0.05). Postoperative intravenous (i.v) tramadol use was found to be higher in chronic cholecystitis (p<0.05). CONCLUSION: LC can be safely applied in recurrent acute cholecystitis attacks in centers experienced in hepatobiliary surgery, regardless of symptom duration and number of attacks. Chronic inflammation increased the consumption of intravenous painkillers.

Keywords

• acute cholecystitis
• laparoscopic surgery
• pain

Akut Kolesistitte Cerrahi Zamanlamanın Önemi ve Postoperatif İntravenöz Tramadol Tüketimi

Öz

Amaç: Laparoskopik kolesistektomi (LC) akut kolesistit için standart tedavi olmasına rağmen, optimal zamanlaması halen tartışmalıdır. Bu çalışmada amacımız acil kolesistektominin ameliyat sonuçları ile tekrarlayan akut kolesistit ile başvuran hastalara uygulanan elektif kolesistektomi vakalarını karşılaştırarak uygun kolesistektomi zamanını belirlemektir. Yöntem: 1 Ocak 2021 – 1 Aralık 2022 tarihleri arasında kolesistektomi planlanan 200 hastanın verileri kullanılrak yapıldı. Bekleme sürecinde tekrarlayan kolesistit atakları ile hastanemize başvuran tüm olgular retrospektif olarak değerlendirildi. Hastaların demografik verileri, hastalığın evresi, ameliyat öncesi ve sonrası hastanede kalış süresi, ameliyat süresi, açık ameliyat oranı, dren kullanımı, içi boş organ yaralanması, safra yolu yaralanması, kanama, yara enfeksiyonu, ameliyat sonrası kolleksiyon toplanma ve ölüm oranları analiz edildi. Bulgular: Tekrarlayan kolesistit ile başvuran 200 hastanın 80’ nine (%40) acil LC (grup 1), 120 hastaya (%60) elektif LC (grup 2) uygulandı. Ameliyat öncesi hastanede kalış süresi grup 2'de anlamlı olarak daha uzun bulundu ve ortalama cerrahi süresi grup 1'de anlamlı olarak daha uzundu (sırasıyla p=0,001 ve p=0,035). Mide veya bağırsak yaralanması, safra yolu yaralanması, yara enfeksiyonu ve mortalite oranında gruplar arasında anlamlı bir fark yoktu. Açık cerrahi ve postoperatif kolleksiyon toplanma oranları her iki grup arasında karşılaştırıldı ve iki grup arasında fark saptanamadı (p>0,05). Kronik kolesistitte postoperatif intravenöz (i.v) tramadol kullanımı daha fazla bulunmuşdur (p<0,05). Sonuç: Hepatobiliyer cerrahi konusunda deneyimli merkezlerde tekrarlayan akut kolesistit ataklarında semptom süresi ve atak sayısından bağımsız olarak LC güvenle uygulanabilmektedir. Kronik inflamasyon intravenöz ağrı kesici tüketimini arttırmıştır.

Anahtar Kelimeler

• akut kolesistit
• laparoskopik cerrahi
• ağrı

Kaynakça

1. Kohga A, Suzuki K, Okumura T, et al. Outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis performed at a single institution. Asian Journal of Endoscopic Surgery. 2018;12(1):74-80.
2. Cao AM, Eslick GD, Cox MR. Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case–control studies. Surgical Endoscopy. 2015;30(3):1172-1182.
3. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N. Early Versus Delayed Cholecystectomy for Acute Cholecystitis, Are the 72 hours Still the Rule? Annals of Surgery. 2016;264(5):717-722.
4. Wu XD, Tian X, Liu MM, Wu L, Zhao S, Zhao L. Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. British Journal of Surgery. 2015;102(11):1302-1313.
5. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N. Early Versus Delayed Cholecystectomy for Acute Cholecystitis, Are the 72 hours Still the Rule? Annals of Surgery. 2016;264(5):717-722.
6. Özkardeş AB, Tokaç M, Dumlu EG, et al. Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study. International Surgery. 2014;99(1):56-61.
7. Saber A, Hokkam EN. Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis. Minimally Invasive Surgery. 2014;2014:1-4.
8. Rajcok M, Bak V, Danihel L, Kukucka M, Schnorrer M. Early versus delayed laparoscopic cholecystectomy in treatment of acute cholecystitis. Bratislava Medical Journal. 2016;117(06):328-331.

9. Miura F, Takada T, Strasberg SM, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences. 2013;20(1):47-54.
10. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: Results of a prospective, randomized clinical trial. Journal of Gastrointestinal Surgery. 2003;7(5):642-645.
11. Takada T. Tokyo Guidelines 2018: updated Tokyo Guidelines for the management of acute cholangitis/acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences. 2018;25(1):1-2.
12. Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of earlyversusdelayed laparoscopic cholecystectomy for acute cholecystitis. British Journal of Surgery. 2009;97(2):141-150.
13. Gomes RM, Mehta NT, Varik V, Doctor NH. No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: A clinicopathological study. Ann Gastroenterol. 2013;26(4):340–345.
14. Bozkurt MA, Gönenç M, Peker KD, Yırgın H, Alış H. Admission after the gold interval in acute calculous cholecystitis: Should we really cool it off? European Journal of Trauma and Emergency Surgery. 2016;43(1):73-77.
15. Navez B, Ungureanu F, Michiels M, et al. Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium. Surgical Endoscopy. 2012;26(9):2436-2445.
16. Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database of Systematic Reviews. Published online June 30, 2013.
17. Cao AM, Eslick GD, Cox MR. Early Cholecystectomy Is Superior to Delayed Cholecystectomy for Acute Cholecystitis: a Meta-analysis. Journal of Gastrointestinal Surgery. 2015;19(5):848-857.
18. Menahem B, Mulliri A, Fohlen A, Guittet L, Alves A, Lubrano J. Delayed laparoscopic cholecystectomy increases the total hospital stay compared to an early laparoscopic cholecystectomy after acute cholecystitis: an updated meta analysis of randomized controlled trials. HPB. 2015;17(10):857-862.