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Erschienen in:
01.06.2021 | perspective
Laparoscopic cholecystectomy in critically ill patients
Erschienen in: European Surgery | Ausgabe 3/2021
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Acute cholecystitis (AC) is a common and potentially life-threatening condition. While early cholecystectomy (surgical removal of the gallbladder independent of the means of access) has been unequivocally established as the gold standard for the management of young and “fit-for-surgery” patients with AC, the optimal management of critically ill and elderly patients with acute cholecystitis in need of gallbladder removal remains a topic of discussion [1‐3]. The surgical management of elderly and critically ill patients is thought to be associated with rates of morbidity and mortality as high as 40 and 13%, respectively [4, 5]. Tokyo guidelines classify the severity of acute cholecystitis in three stages (Table 1).
Table 1
Tokyo Guidelines for the classification of acute cholecystitis 2018
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1
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Mild
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Acute cholecystitis without any signs of severe inflammation, no organ dysfunction
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2
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Moderate
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The presence for one or more of the following:
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Elevated white blood cell count (>18,000 cells/mm3)
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Palpable mass in the right upper quadrant
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Duration >72 h
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Marked local inflammation including biliary peritonitis, pericholecystitic abscess, hepatic abscess, gangrenous cholecystitis, emphysematous cholecystitis
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3
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Severe
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Cardiovascular dysfunction: hypotension requiring treatment with dopamine ≥5 μg/kg per min or any dose of norepinephrine
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Neurological dysfunction: decreased level of consciousness
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Respiratory dysfunction: PaO2/FiO2 ratio <300
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Renal dysfunction: oliguria, creatinine >2.0 mg/dl
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Hepatic dysfunction: PT-INR >1.5
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Hematological dysfunction: platelet count <100,000/mm3
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