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Erschienen in: European Surgery 3/2021

01.06.2021 | perspective

Laparoscopic cholecystectomy in critically ill patients

verfasst von: Arvin Imamovic, MD Doris Wagner, Peter Kornprat, Heinz Bacher, Georg Werkgartner, Hans-Joerg Mischinger

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 [ 13]. 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
1
Mild
Acute cholecystitis without any signs of severe inflammation, no organ dysfunction
2
Moderate
The presence for one or more of the following:
Elevated white blood cell count (>18,000 cells/mm 3)
Palpable mass in the right upper quadrant
Duration >72 h
Marked local inflammation including biliary peritonitis, pericholecystitic abscess, hepatic abscess, gangrenous cholecystitis, emphysematous cholecystitis
3
Severe
Cardiovascular dysfunction: hypotension requiring treatment with dopamine ≥5 μg/kg per min or any dose of norepinephrine
Neurological dysfunction: decreased level of consciousness
Respiratory dysfunction: PaO 2/FiO 2 ratio <300
Renal dysfunction: oliguria, creatinine >2.0 mg/dl
Hepatic dysfunction: PT-INR >1.5
Hematological dysfunction: platelet count <100,000/mm 3
Tokyo guidelines’ suggested treatment algorithm for severe cholecystitis as published in Okamoto et al. [ 11]. PaO2 partial oxygen staturation, FiO2 fraction of inspired oxygen, PT-INR prothormbine time international normalized ratio
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Metadaten
Titel
Laparoscopic cholecystectomy in critically ill patients
verfasst von
Arvin Imamovic
MD Doris Wagner
Peter Kornprat
Heinz Bacher
Georg Werkgartner
Hans-Joerg Mischinger
Publikationsdatum
01.06.2021
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 3/2021
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-021-00717-9