Is combined rather than single antibiotic therapy actually reasonable in patients with acute calculous cholecystitis?

SUMMARY OBJECTIVE Acute calculous cholecystitis (AC) is a frequently encountered emergency surgery disease and its standard treatment is cholecystectomy. In patients with high risk in surgery, antibiotic treatment (AT) is important. In routine clinical practices, antibiotics are frequently used either as single or in combination in the treatment of AC. This study examined whether or not combined antibiotic treatment (CAT) had superiority over single antibiotic treatment (SAT) in AC. METHODS Patients with cholecystitis who received treatment in the period of 2016-2019 were retrospectively examined. The treatment procedures applied, patient findings, and laboratory data were analyzed using relevant statistical software. The patients were categorized into groups based on the treatment approaches applied, and the effects of SAT and CAT on infection parameters were analyzed. RESULTS In all, 184 patients received treatment for AC, with a mean age of 57.7, and the female-to-male ratio was 77:107. Of these, 139 patients received SAT and 45 received CAT. No significant difference was found in terms of effectiveness between the SAT and CAT in the patients who received early cholecystectomy treatment and those who received medical treatment with noninvasive intervention. CONCLUSIONS In patients with AC, antibiotics are commonly used either as single or in combination for prophylaxis and therapeutic purposes. As no significant difference was observed between single and combined use in terms of treatment effectiveness and hospitalization duration, CAT is not recommended due to its possibility of allergic side effects, toxicity, and cost-increasing effects.

Efectividad de la profilaxis antibiótica en pacientes con colecistitis aguda sometidos a colecistectomía laparoscópica / Effectiveness of antibiotic prophylaxis in acute cholecystitis patients undergoing laparoscopic cholecystectomy

OBJETIVO: Determinar la efectividad de la profilaxis antibiótica con Cefazolina en pacientes sometidos a colecistectomía laparoscópica por Colecistitis Aguda MATERIAL Y MÉTODOS: Cohorte Prospectiva POBLACIÓN: Pacientes mayores de 18 años, con patología litiásica vesicular aguda, sometidos a colecistectomía laparoscópica. SEDE Y TEMPORALIDAD: Hospital Obrero Nº 1 de la Caja Nacional de Salud La Paz ­ Bolivia. Período comprendido entre el 1 de Julio de 2016 al el 31 de Diciembre de 2016. RESULTADOS: Se incluyeron 95 pacientes con Colecistitis Aguda divididos en dos grupos, el Grupo A (SIN profilaxis antibiótica) compuesto por 50 sujetos y el Grupo B (CON profilaxis antibiótica) de 45 sujetos. La edad promedio fue de 48 años, el peso de 70 kilos, la talla de 165 cm y el IMC de 27,4 km/ m2. El tiempo operatorio promedio fue de 50 (±22,815) minutos en el total del grupo, 45 min. (±18,460) en el grupo A y 60 min (±24,862) en el grupo B. La conversión a cirugía abierta fue de 9 sujetos (9,5%). La infección del sitio operatorio se presentó en 47 sujetos (49,5%), 30 sujetos (60%) EN EL GRUPO A y 18 en el grupo B (40%). El OR calculado es de 0,444 (IC 95% 0,195 ­ 1,011). CONCLUSIONES: La administración de Cefazolina en forma profiláctica, parece no disminuir la probabilidad de infección del sitio operatorio en colecistitis aguda abordada por laparoscopía

OBJECTIVE: To determine the effectiveness of antibiotic prophylaxis with Cefazolin in patients undergoing laparoscopic cholecystectomy due to Acute Cholecystitis. METHODS: Prospective Cohort POPULATION: Adult patients (older than 18 years), with acute lithiasic cholecystitis, who underwent laparoscopic cholecystectomy. PLACE AND TEMPORALITY: Hospital Obrero No. 1 of the Caja Nacional de Salud La Paz ­ Bolivia, from July to December 2016. RESULTS: A total of 95 patients with Acute Cholecystitis were enrolled and divided in to two groups, group A (without antibiotic prophylaxis) composed of 50 subjects and Group B, (with antibiotic prophylaxis) 45 subjects. The mean age was 48 years old, weight 70 Kg, hight 165 cm and a BMI of 27.4 kg/M2. The mean operating time was 50 minutes (+- 22.185), group A 45 minutes and group B 60 min. Conversion to open surgery happened in 9 patients (9,5%), all in group B. Surgical Site infection (SSI) occurred in 47 patients (49.5%), of whom 30 patients belong to group A (60%) and 18 patients to group B (40%). The calculated Odds ratio is 0.444 (IC 95% 0,195-1.011). There were no bile duct injuries or morality in this study. CONCLUSIONS: The prophylactic administration of Cefazolin does not seems to decrease the probability of SSI in acute cholecystitis treated laparoscopically.

Acute cholecystitis; early versus interval cholecystectomy for a comparative study

Gallstones are common biliary pathology. The Vast majority of subjects are asymptomatic. About 0.2% of the population suffering from gallstones develop acute cholecystitis every year. In case of acute calculous cholecystitis, cholecystectomy can be performed early i.e during the same admission or interval i.e after 6 weeks of conservative management. To compare the early and interval cholecystectomy in acute calculous cholecystitis for morbidity, postoperative hospital stay, total hospital stay and complications. Study Design: Quasi-experimental study. Department of Surgery Bahawal Victoria Hospital Bahawalpur. Two year study from December 2007 to December 2009. Sixty patients fulfilling the inclusion criteria were selected for this study. The patients were divided into two groups. Group A patients were managed by early cholecystectomy and group B patients by interval cholecystectomy. Postoperatively patients were evaluated for postoperative hospital stay, total hospital stay and postoperative complications. The mean age of the patients in group A was 42.2 + 1 0.7 years and in group B was 42.2+ 1 0.7 years. The Male to female ratio was 1 :4 in both groups. The mean postoperative hospital stay in group A was 4.0+ 1 .Sdays and in group B was 3.8+ 1 .4 days. The mean total hospital stay in group A was 6.5 + 1 .7 days and in group B was 10.2 + 1 .3 days. The P value was less than 0.001, which was significant. In distribution of postoperative complications, in group A there were 1[3.3%] injury to biliary tree, 4[13.3%] wound infection, 1[3.3%] wound haematoma, 3 [10%] seroma and 1[3.3%] wound dehiscence. While in group B there were 1 [3.3%] injury to biliary tree, 3[10%] wound infection,2 [6.7%] wound haematoma, 2[6.7%] and no patient of wound dehiscence. Our study suggests that early cholecystectomy is a better treatment option than interval cholecystectomy because it has less total hospital stay, needs single hospital visit and has no risk of developing complications during wait for surgery