Today is history again. Today is the 4th birthday of “Surgical Thoughts: A blog about surgery”. For the last four years two posts were published each month in a total of 94. Several areas of surgery have been covered as well as videos about different minimally invasive surgical techniques. The feedback from the readers has been the fuel that makes me keep working in this project. To you all, thank you for reading and comment.
In this time of celebration, a new video is now available. Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in worldwide general surgery departments. Cholecystectomy is the ultimate proof of the advantages of minimally invasive surgery. Laparoscopy became the gold standard without surprises. In that setting the aim of this video is to present indications for laparoscopic cholecystectomy, trocar placement according to American technique (French technique is different), and to summarize how it is performed.
This minimally invasive technique can be performed both in an elective setting and in an emergency environment. This last one includes acute cholecystitis, a frequent pathology treated by worldwide general surgeons. There are guidelines advising for early cholecystectomy for acute cholecystitis depending on severity grade and if patient is capable of withstanding surgery (Tokyo Guidelines 2018). Although with no statistical differences, delayed cholecystectomy has less biliary complications and less operative time than early cholecystectomy. Additionally, a conversion rate of 45% has been reported for early cholecystectomy (Cochrane Review). The great advantage of early cholecystectomy is avoiding new acute episodes while waiting for the elective surgery. However, surgeons must be aware that acute cholecystitis usually has a benign outcome with medical treatment (opposite to acute appendicitis), and delayed surgery can come without acute exacerbations within the waiting. Although without statistical significance, the biliary complications of early cholecystectomy can have a huge negative impact in Q-o-L of patients (hepatic transplant can be the ultimate result). According to several studies the only factor with statistical significance is hospital length of stay, which is shorter for early cholecystectomy.
I am not saying early cholecystectomy should not be offer to patients with acute cholecystitis, nor that delayed cholecystectomy is better. I would like to make the reader think about the following question. If only length of stay has statistical difference and conversion rate and complications can be higher in number for early cholecystectomy (even without statistical significance), is it worth the risk of having a severe biliary complication just to save some days in the hospital?
Study, learn, read the guidelines and build your mind. Then question everything you have learned.
Once again thank you for reading “Surgical Thoughts: A blog about surgery”.
A new year is coming…
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Dr. Carlos Eduardo Costa Almeida
General Surgeon