Overcoming of a “surgical dogma” in acute cholecystitis treated in postponed emergency

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COD: 287-292 Categorie: ,

Pierpaolo Caputo, Giorgio Rossi*, Massimo Faccini**, Pierluigi Carzaniga

Ann. Ital. Chir., 2009; 80: 287-292

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AIM: To demonstrate the overcoming of a surgical dogma related to acute cholecystitis treatment, in particular to the
timing of the operation.
METHODS: One hundred cases of observed acute cholecystitis, submitted to an emergency postponed laparoscopic cholecystectomy
surgery and histological control of specimens to evaluate rate of surgical complications and rate of reconvertion
to open surgery.
RESULTS: The complications rate observed and the surgical conversion to open technique was only 1% where in 96%
of the cases the histological examination of the specimen confirmed the state of acute inflammation. Therefore there was
a substantial success rate of laparoscopic therapy even in emergency situations, in spite of an overcoming of the conventional
timing within 72 hours of surgery for acute cases, which has few restrictions from some authors. The reasons
allowing in safety that time extension were ascribed to the laparoscopic procedure, apt to overcome the anatomo-pathological
barriers through an accurate vision of the operative field, and the use of specialized devices allowing the coagulative
dissection of inflamed tissues.
CONCLUSIONS: Postponed colecistectomy in acute cholecystitis, in extention of the canonical coded timing of 72 hours,
confirmed to be a safe and successful procedure, even in emergency, with only rare exceptions.

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