Outcome of Laparoscopic Cholecystectomy for Patients with Acute Cholecystitis at Trat Hospital
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Abstract
BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard method utilized for treating gallstones. Understanding the factors that can affect the difficulty of surgery can be beneficial for planning treatment and reducing complications.
OBJECTIVES: This study aimed to review treatment data of acute cholecystitis patients over a 5-year period and identify the factors influencing LC difficulty.
METHODS: The research involved a retrospective review of the medical records for 287 acute cholecystitis patients who had undergone emergency or urgent surgery at Trat Hospital from October 1, 2018 to September 30, 2023. Statistical analysis was performed using descriptive statistics, Chi-square, Fisher's exact test, independent t-test and Multiple logistic regression.
RESULTS: From the study of 125 patients who had undergone LC for acute cholecystitis, it was found the majority were female (63.2%). The average age was 55 years old, and 49.6% were obese (BMI ≥25 kg/m²), with the most common comorbidities being hypertension (37.6%), dyslipidemia (22.4%), and diabetes (12.0%). The patients were divided into two groups comprising 44 patients (35.2%) in the "easy to operate" group and 81 patients (64.8%) in the "difficult to operate" group. Significant factors affecting surgical difficulty were an onset-to-surgery time greater than 72 hours (AOR=3.33; 95% CI, 1.51–7.38; p=0.003) and the presence of diabetes (AOR=3.90; 95% CI, 1.04–1.96; p=0.04). However, no factors were found to significantly increase the likelihood of conversion to open surgery. Regarding complications, the LC group had fewer cases of surgical-related anemia and wound infections compared to open cholecystectomy (OC), though no difference was observed in biliary duct injuries. Additionally, the LC group had shorter hospital stays and lower costs compared to the OC group.
CONCLUSIONS: The significant factors impacting surgical difficulty are the time from onset to surgery and diabetes. However, these factors were not found to be associated with a greater chance of conversion to open surgery.
Thaiclinicaltrials.org number, TCTR20241215008
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