RESUMEN
AIM: Acute cholecystitis (AC) is one of the most frequent pathologies treated in urgency. An immediate surgical intervention for frail patients who are ineligible for surgery as a result of severe co-morbidities is questionable. The aim of this study is to investigate the safety and the management of percutaneous cholecistostomy (PC) in high-risk surgical patients. MATERIALS AND METHODS: In the period of time January 2015 - May 2021 we observed 1105 patients admitted with acute cholecystitis in our Department. In the group with severe cholecystitis (160 patients, 14.48%), 137 (12.39%) were submitted to immediate surgery, and 23 (4.8%) were treated with PC. All these patients were non-responding to conservative management. Initially, we used PC as a definitive treatment; from the second half of 2018 PC was implemented as a bridge to surgery. RESULTS: Clinically, symptoms resolved in all the 23 patients. Mortality was nihil and no complication was recorded. PC was used as definitive treatment in 14 cases, wheres in 9 patients PC was intended as a-bridge-to-surgery treatment, and was followed by cholecystectomy. DISCUSSION: 2017 guidelines, of World Society of Emergency Surgery recommended PC as a safe and effective management of AC in patients with multiple comorbidities. In this group of patients PC achieves a prompt resolution of clinical symptoms and is superior to conservative management. There are no absolute contraindications to PC. CONCLUSIONS: PC is a safe and less invasive treatment of AC for patients with prohibitive surgical risk. It may be used as bridge to surgery to switch high-risk for moderate-risk patients, more suitable for a safe and definitive surgical treatment. KEY WORDS: Acute cholecystitis, High-risk surgical patients, Percutaneous cholecystostomy.
Asunto(s)
Colecistitis Aguda , Colecistostomía , Colecistectomía/efectos adversos , Colecistitis Aguda/cirugía , Colecistostomía/efectos adversos , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: The ideal level of ligation of the inferior mesenteric artery (IMA) during resection for colorectal cancer is still controversial. The aim of this study was to demonstrate the real advantages and, above all, the adequacy of oncological staging after a low ligation of the IMA with additional LN retrieval in patients undergoing surgery for colorectal cancer. MATERIALS AND METHODS: Between January 2013 and December 2020, 157 patients who underwent curative resection of a primary colorectal tumor were retrospectively included: 64 patients underwent high ligation of the IMA and 93 patients underwent low ligation of the IMA with additional LN retrieval. Results - Mean number of lymphnodes harvested (the median number of harvested nodes was 16.2 in "high ligation" group vs 15.4 in "low ligation" group), operation time (272 minutes vs 293 minutes), intraoperative blood loss (40 cc vs 53 cc) and recovery time (median postoperative hospitalization was 6.4 days in both groups) were not significantly different between the groups. DISCUSSION: High ligation of the IMA preserves an adequate length of the colon to perform a successful anastomosis and facilitates apical LN dissection. However, it may be associated with an increased risk of anastomotic leakage. Low ligation of the IMA is less invasive and it is associated with a better preservation of genitourinary function and, futhermore, with an accurate oncological clearance. CONCLUSION: Low ligation of the IMA with additional LN retrieval might be an oncologically safe and less invasive procedure in the surgical management of patients with colorectal cancer. KEY WORDS: Colorectal cancer, Inferior mesenteric artery, Ligation.