Surgical treatment of acute cholecystitis

Kirurško liječenje akutnog kolecistitisa oduvijek je bio veliki izazov za kiruršku struku. Postoje dvije metode kolecistektomije: laparoskopska i otvorena. Laparoskopska kolecistektomija je prvi puta izvedena 1985. godine, a razvojem tehnologije i uvježbavanjem kirurga, postepeno zamjenjuje otvorenu kolecistektomiju, te postaje zlatni standard liječenja akutnog kolecistitisa. Mnogi radovi ukazuju na prednosti laparoskopske nad otvorenom metodom. U ovom radu analizirani su pacijenti operirani u Kliničkom bolničkom centru (KBC) Zagreb, u razdoblju od 3 godine (2017. - 2019.), pod dijagnozom K80.0 i K80.1 prema MKB-10 klasifikaciji. Uspoređene su laparoskopska i otvorena metoda kolecistektomije, te konverzije po: broju izvedenih zahvata, učestalosti pojedinog stupnja težine akutnog kolecistitisa po Tokyo smjernicama iz 2018. godine, učestalosti intraoperativnih i postoperativnih komplikacija, trajanju postoperativne hospitalizacije, a dodatna analiza je napravljena u podgrupi pacijenata dobne skupine ≥ 75 godina starosti. Klasifikacija po Strasbergu je korištena za opisivanje lezija žučnih puteva. Operirano je 274 pacijenata. U 240 (87,60%) pacijenata kolecistektomija je započeta laparoskopskom metodom, a od tih 240 pacijenata, konverzija je bila potrebna u 27 (11,25%). Otvorenom metodom operirano je 34 (12,40%) pacijenata. Nakon analize ovih podataka i podataka iz literature, zaključeno je da je laparoskopska kolecistektomija superiorna metoda u liječenju akutnog kolecistitisa, da rana laparoskopska metoda pokazuje bolje rezultate od odgođenog zahvata i da je laparoskopska kolecistektomija sigurna i u dobnoj skupini ≥ 75 godina starosti. Kirurg treba preoperativnom procjenom ASA fizikalnog statusa, Charlsonovog indeksa komorbiditeta, čimbenika rizika za tešku laparoskopiju i čimbenika rizika za nastanak komplikacija odlučiti koja bi metoda bila pogodna za svakog pojedinog pacijenta.Surgical treatment of acute cholecystitis has always been a great challenge for the surgical profession. There are two methods of cholecystectomy: laparoscopic and open. The first laparoscopic cholecystectomy was performed in 1985. With the development of technology and the training of surgeons, it has been gradually replacing open cholecystectomy, and is becoming the gold standard for the treatment of acute cholecystitis. Many papers point out to the advantages of laparoscopic over the open method. This paper analyzes patients who were operated at the University Hospital Center (KBC) Zagreb, in a three year period (2017. – 2019.), classified as K80.0 and K80.1 according to the ICD-10 classification. The laparoscopic and open method of cholecystectomy were compared, as well as conversions by the following: number of performed procedures, frequency of individual severity of acute cholecystitis according to Tokyo guidelines from 2018, frequency of intraoperative and postoperative complications, duration of postoperative hospitalization. Subgroup of patients in the age group of ≥ 75 years old was additionally analyzed. The Strasberg classification was used to describe bile duct injuries. In total, 274 patients were operated. In 240 (87.60%) patients cholecystectomy was started by laparoscopic method, and out of those 240 patients, conversion was required in 27 (11.25%). 34 (12.40%) patients underwent open surgery. After analyzing data from this paper and data from the literature, it was concluded that laparoscopic cholecystectomy is a superior method in the treatment of acute cholecystitis, that early laparoscopic method shows better results than delayed surgery and that laparoscopic cholecystectomy is safe in the age group ≥ 75 years. The surgeon should decide which method would be appropriate for each patient by preoperative assessment of ASA physical status, Charlson's comorbidity index, risk factors for severe laparoscopy, and risk factors for complications