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Surg Endosc ; 35(5): 2206-2210, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32394176

RESUMO

BACKGROUND: Laparoscopic cholecystectomy (LC) is regarded as the first choice for patients with gallbladder diseases, but biliary injury (BDI) still poses serious risks upon implementation of LC. Recently, bailout surgery (BOS; partial cholecystectomy or subtotal cholecystectomy) has been proposed to avoid not only BDI but also major vessels injuries. In this retrospective study, we evaluated the preoperative and perioperative risk factors regarding conversion from total cholecystectomy (TC) to BOS. METHODS: A total of 584 patients who underwent elective LC for gallbladder diseases between January 2006 and April 2018 were analyzed. The patients were divided into the TC group (including conversion open TC) and the BOS group. Univariate and multivariate analyses using preoperative and perioperative clinicolaboratory characteristics were performed to investigate the most significant risk factors associated with conversion to BOS. RESULTS: There were a total of 33 patients in the BOS group (35 men and 18 women), with 19 patients who underwent open BOS and 14 patients who underwent laparoscopic BOS. From the univariate analyses, age, albumin level, CRP level, WBC, lymph. ratio, neutro. ratio, platelet count (PLt), neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, CRP-to-alb ratio, intercurrent acute cholecystitis (AC), and previous biliary tract drainage (PBTD) were considered as risk factors for the conversion to BOS. Multivariate analysis using the 13 parameters selected from the univariate analyses demonstrated that AC (p = 0.04), albumin level (p = 0.01) and age (p = 0.04) were significant risk factors. CONCLUSION: Patients with PBTD and AC have a high risk upon conversion from LTC to BOS, and for such patients, LC should be performed cautiously.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia/métodos , Colecistite Aguda/etiologia , Doenças da Vesícula Biliar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistite Aguda/cirurgia , Drenagem , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica Humana/análise
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