Ulus Travma Acil Cerrahi Derg. 2022; 28(4): 508-512 | DOI: 10.14744/tjtes.2022.81908

Tekrarlayan akut kolesistit ataklarýnda kolesistektomi zamanlamasý

Ecem Memiþoðlu, Ramazan Sarý
Kartal Dr. Lütfi Kýrdar Þehir Hastanesi, Genel Cerrahi Kliniði, Ýstanbul

AMAÇ: Laparoskopik kolesistektomi akut kolesistit tedavisinde standart tedavi olmasýna raðmen optimal zamaný hala tartýþmalýdýr. Bu çalýþmadaki amacýmýz, tekrarlayan akut kolesistit tablosuyla baþvuran hastalarda acil ve elektif kolesistektominin sonuçlarýný karþýlaþtýrarak uygun kolesistektomi zamanýný belirlemektir.
GEREÇ VE YÖNTEM: Ocak 2019 ile Ocak 2022 tarihleri arasýnda geç kolesistektomi planlanan ve bekleme sürecinde tekrarlayan kolesistit ataklarý ile hastanemize baþvuran 434 hastanýn verileri geriye dönük olarak incelendi. Hastalarýn demografik verileri, Tokyo Guidelines 2018’e göre evresi, ameliyat öncesi ve sonrasý hastanede kalýþ süresi, ameliyat süresi, açýða geçiþ oraný, dren kullanýmý, içi boþ organ yaralanmasý, safra yolu yaralanmasý, kanama, yara yeri enfeksiyonu, ameliyat sonrasý koleksiyon ve mortalite oranlarý deðerlendirildi.
BULGULAR: Tekrarlayan kolesistit ataðý ile baþvuran toplam 434 hastanýn 176’sýna (%40.5) acil laparoskopik kolesistektomi (grup 1), 258’ine (%59.5) elektif laparoskopik kolesistektomi (grup 2) uygulandý. Ameliyat öncesi hastanede yatýþ süresi grup 2’de, ortalama ameliyat süresi grup 1’de anlamlý olarak daha uzun idi (sýrasýyla, p=0.001 ve p=0.035). Her iki grupta mide veya baðýrsak yaralanmasý, safra yolu yaralanmasý, yara yeri enfeksiyonu ve mortalite saptanmadý. Gruplar arasýnda açýða geçiþ ve ameliyat sonrasý koleksiyon oranlarýnda anlamlý bir fark yoktu (p>0.05). TARTIÞMA: Hepatobiliyer cerrahide deneyimli merkezlerde, tekrarlayan akut kolesistit ataklarýnda semptom süresi ve atak sayýsýndan baðýmsýz olarak laparoskopik kolesistektomi güvenle yapýlabilir.

Anahtar Kelimeler: Acil laparoskopik kolesistektomi, elektif laparoskopik kolesistektomi, tekrarlayan akut kolesistit.

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Timing of cholecystectomy in recurrent attacks of acute cholecystitis

Ecem Memiþoðlu, Ramazan Sarý
Departmant of General Surgery, Kartal Dr. Lütfi Kýrdar City Hospital, Ýstanbul-Turkey

BACKGROUND: Although laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis, its optimal timing is still controversial. In this study, our aim is to determine the appropriate cholecystectomy time by comparing the results of emergency and elective cholecystectomy in patients presenting with recurrent acute cholecystitis.
METHODS: Between January 2019 and January 2022, the data of 434 patients who were scheduled for late cholecystectomy and were admitted to our hospital with recurrent cholecystitis attacks during the waiting period were retrospectively evaluated. Demo-graphic data of patients, stage according to Tokyo Guidelines 2018, duration of hospital stay before and after surgery, surgery dura-tion, open surgery rate, drain use, hollow organ injury, biliary tract injury, bleeding, wound infection, post-operative collection, and mortality rates were analyzed.
RESULTS: Emergency LC (group 1) was performed in 176 (40.5%) of 434 patients presenting with recurrent cholecystitis, and elec-tive LC (group 2) was performed in 258 (59.5%) patients. Pre-operative hospital stay was significantly longer in group 2, and mean surgery duration was significantly longer in group 1 (p=0.001 and p=0.035, respectively). Gastric or intestinal injury, biliary tract injury, wound infection, and mortality were not detected in either group. There was no significant difference between the groups in the rate of open surgery and postoperative collection rates (p>0.05).
CONCLUSION: In centers experienced in hepatobiliary surgery, LC can be safely performed in recurrent acute cholecystitis attacks, regardless of symptom duration and the number of attacks.

Keywords: Elective laparoscopic cholecystectomy, emergency laparoscopic cholecystectomy, recurrent acute cholecystitis.

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