Gioia Brachini (Rome / IT), Pierfranco Maria Cicerchia (Rome / IT), Martina Zambon (Rome / IT), Sara Giovampietro (Rome / IT), Enrico Spalice (Rome / IT), Eleonora Cianci (Rome / IT), Bruno Cirillo (Rome / IT), Simona Meneghini (Rome / IT), Duranti Giulia (Rome / IT), Andrea Mingoli (Rome / IT)
Abstract text (incl. references and figure legends)
INTRODUCTION: Acute cholecystitis (AC) is common in acute care surgery. According to the Tokyo Guidelines 2018, the gold standard of treatment of AC is early laparoscopic cholecystectomy (LC). Even in high experienced settings, however, complication rate is high. Though biliary and vascular injuries are more frequent in LC rather than open cholecystectomy, the advantages of laparoscopy should be taken into account. The cystic duct and artery should be cautiously recognized before section of any element to avoid biliary and vasculr injuries during LC. In 1995, Strasberg introduced the Critical View of Safety (CVS) in cholecystectomy. Nevertheless, if anatomical landmarks couldn"t be safely identified, bailout procedures (subtotal or top-down cholecystectomy, open conversion) should be an alternative.
MATERIALS AND METHODS: We retrospectively reviewed 316 consecutive LC for AC, at our institution, from Jan 1, 2013 to Sept 15, 2022. In the period 2013-17, some members of thes urgical team used to opt for open approach or liberal conversion in difficult cases. From 2018, our team shifted to LC for AC as a matter of principle, relying on CVS and bailout procedures. M/F ratio was 207/109, mean age 60,7 yrs, ASA status 2.06, TG18 grading 1.47, time to surgery 98 hrs, bailout rate 9%, operative time 122 min, LOS 5.04 days. Three patients died for septic shock. Comparing the 1st and 2nd period, open/lap ratio was 22.6% and 5.5%, conversion rate was 12.3% and 9.6%; morbidity rate was 25% (1 minor injury of biliary tree, 1 choledocal fistula, 4 minor bleeding) and 16.9%(2 minor biliary injuries, 1 choledocal fistula, 1 minor bleeding).
DISCUSSION AND CONCLUSIONS: surgical treatment of AC cases could be technically challenging. Some key steps have been identified to realize the safest LC. In this series, the shift to baseline application of these criteria had significanty modified the early and mid-term outcomes, demonstrating efficacy and safety of the approach.
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