Comparative Analysis of laparoscopic cholecystectomy versus Standard Care in acute appendicitis
DOI:
https://doi.org/10.5281/zenodo.22813411Keywords:
laparoscopic cholecystectomy, acute appendicitis, acute cholecystitis, standard care, comparative outcomesAbstract
Background: Laparoscopic surgery has progressively replaced standard, open care as the preferred operative approach for the common causes of the acute surgical abdomen, but comparative evidence spanning more than one condition within the same care pathway remains limited. This study compares outcomes of laparoscopic versus standard care across acute cholecystitis and acute appendicitis managed within a shared emergency general-surgery pathway.
Methods: In this retrospective comparative cohort analysis, 428 adults admitted with acute cholecystitis (n=256) or acute appendicitis (n=172) were assigned to a laparoscopic or standard-care arm according to the operative approach used. Operative time, length of stay, 30-day composite complication rate, and conversion rate were compared between arms within each condition.
Results: The laparoscopic arm had shorter median length of stay and a lower composite complication rate than the standard-care arm in both cohorts (cholecystitis: 2.1 vs 5.4 days, 8.1% vs 17.9%; appendicitis: 1.4 vs 3.2 days, 5.8% vs 13.7%), with a numerically larger relative benefit in the cholecystitis cohort. Conversion occurred in 9.3% of laparoscopic cholecystectomies and 4.1% of laparoscopic appendectomies, with no 30-day mortality in either cohort.
Conclusion: Laparoscopic surgery was associated with shorter stay and fewer complications than standard care across two distinct acute-abdomen presentations, supporting a laparoscopic-first approach where patient and disease factors permit, while prospective cross-condition data are needed to confirm this consistency.
References
Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J.H., Drake, F.T. (2015) Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet, 386(10000): 1278-1287. DOI: 10.1016/S0140-6736(15)00275-5
Sartelli, M., Baiocchi, G.L., Di Saverio, S., Ferrara, F., Labricciosa, F.M., Ansaloni, L., et al. (2018) Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World Journal of Emergency Surgery, 13: 19. DOI: 10.1186/s13017-018-0179-0
Strasberg, S.M., Hertl, M., Soper, N.J. (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. Journal of the American College of Surgeons, 180(1): 101-125.
Keus, F., de Jong, J.A., Gooszen, H.G., van Laarhoven, C.J. (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database of Systematic Reviews, (4): CD006231. DOI: 10.1002/14651858.CD006231
Sauerland, S., Jaschinski, T., Neugebauer, E.A. (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews, (10): CD001546. DOI: 10.1002/14651858.CD001546.pub3
Jaschinski, T., Mosch, C.G., Eikermann, M., Neugebauer, E.A., Sauerland, S. (2018) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews, 11: CD001546. DOI: 10.1002/14651858.CD001546.pub4
Livingston, E.H., Woodward, W.A., Sarosi, G.A., Haley, R.W. (2007) Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Annals of Surgery, 245(6): 886-892. DOI: 10.1097/01.sla.0000256391.05233.aa
Andersson, R.E. (2004) Meta-analysis of the clinical and laboratory diagnosis of appendicitis. British Journal of Surgery, 91(1): 28-37. DOI: 10.1002/bjs.4464
Okamoto, K., Suzuki, K., Takada, T., Strasberg, S.M., Asbun, H.J., Endo, I., et al. (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1): 55-72. DOI:
1002/jhbp.516 10. Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., et al. (2020) Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery, 15: 27. DOI: 10.1186/s13017-020-00306-3
Guller, U., Hervey, S., Purves, H., Muhlbaier, L.H., Peterson, E.D., Eubanks, S., et al. (2004) Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Annals of Surgery, 239(1): 43-52. DOI: 10.1097/01.sla.0000103071.35986.c1
Masoomi, H., Mills, S., Dolich, M.O., Ketana, N., Carmichael, J.C., Nguyen, N.T., et al. (2011) Comparison of outcomes of laparoscopic versus open appendectomy in adults: data from the Nationwide Inpatient Sample (NIS), 2006-2008. Journal of Gastrointestinal Surgery, 15(12): 2226-2231. DOI: 10.1007/s11605-011-1613-8
Ingraham, A.M., Cohen, M.E., Bilimoria, K.Y., Pritts, T.A., Ko, C.Y., Esposito, T.J. (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery, 148(4): 625-635. DOI: 10.1016/j.surg.2010.07.025
Coccolini, F., Catena, F., Pisano, M., Gheza, F., Fagiuoli, S., Di Saverio, S., et al. (2015) Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. International Journal of Surgery, 18: 196-204. DOI: 10.1016/j.ijsu.2015.04.083
Yamashita, Y., Takada, T., Strasberg, S.M., Pitt, H.A., Gouma, D.J., Garden, O.J., et al. (2013) TG13 surgical management of acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 20(1): 89-96. DOI: 10.1007/s00534-012-0567-x
Zafar, S.N., Obirieze, A., Adesibikan, B., Cornwell, E.E. 3rd, Fullum, T.M., Tran, D.D. (2015) Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surgery, 150(2): 129-136. DOI: 10.1001/jamasurg.2014.2339
Banz, V., Gsponer, T., Candinas, D., Güller, U. (2011) Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Annals of Surgery, 254(6): 964-970. DOI: 10.1097/SLA.0b013e318228d31c
Halbert, C., Altieri, M.S., Yang, J., Meng, Z., Chen, H., Talamini, M., et al. (2016) Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy. Surgical Endoscopy, 30(10): 4294-4299. DOI: 10.1007/s00464-016-4747-0
Flum, D.R., Dellinger, E.P., Cheadle, A., Chan, L., Koepsell, T. (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA, 289(13): 1639-1644. DOI: 10.1001/jama.289.13.1639
Gurusamy, K.S., Davidson, C., Gluud, C., Davidson, B.R. (2013) Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database of Systematic Reviews, (6): CD005440. DOI: 10.1002/14651858.CD005440.pub3
Ansaloni, L., Pisano, M., Coccolini, F., Peitzmann, A.B., Fingerhut, A., Catena, F., et al. (2016) 2016 WSES guidelines on acute calculous cholecystitis. World Journal of Emergency Surgery, 11: 25. DOI: 10.1186/s13017-016-0082-5
Talan, D.A., Di Saverio, S. (2021) Treatment of acute uncomplicated appendicitis. New England Journal of Medicine, 385(12): 1116-1123. DOI: 10.1056/NEJMcp2107675
Wakabayashi, G., Iwashita, Y., Hibi, T., Takada, T., Strasberg, S.M., Asbun, H.J., et al. (2018) Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1): 73-86. DOI: 10.1002/jhbp.517
Gutt, C.N., Encke, J., Koninger, J., Harnoss, J.C., Weigand, K., Kipfmuller, K., et al. (2013) Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study). Annals of Surgery, 258(3): 385-393. DOI: 10.1097/SLA.0b013e3182a1599b
Salminen, P., Paajanen, H., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., et al. (2015) Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA, 313(23): 2340-2348. DOI: 10.1001/jama.2015.6154
Flum, D.R., Davidson, G.H., Monsell, S.E., Shapiro, N.I., Odom, S.R., Sanchez, S.E., et al. (2020) A randomized trial comparing antibiotics with appendectomy for appendicitis. New England Journal of Medicine, 383(20): 1907-1919. DOI: 10.1056/NEJMoa2014320
Vons, C., Barry, C., Maitre, S., Pautrat, K., Leconte, M., Costaglioli, B., et al. (2011) Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet, 377(9777): 1573-1579. DOI: 10.1016/S0140-6736(11)60410-8
Hansson, J., Körner, U., Khorram-Manesh, A., Solberg, A., Lundholm, K. (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. British Journal of Surgery, 96(5): 473-481. DOI: 10.1002/bjs.6482
Way, L.W., Stewart, L., Gantert, W., Liu, K., Lee, C.M., Whang, K., et al. (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Annals of Surgery, 237(4): 460-469. DOI: 10.1097/01.SLA.0000060680.92690.E9
Di Saverio, S., Sibilio, A., Giorgini, E., Biscardi, A., Villani, S., Coccolini, F., et al. (2014) The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics for the treatment of patients with right lower quadrant abdominal pain and long-term follow-up. Annals of Surgery, 260(1): 109-117. DOI: 10.1097/SLA.0000000000000560
Sartelli, M., Chichom-Mefire, A., Labricciosa, F.M., Hardcastle, T., Abu-Zidan, F.M., Adesunkanmi, A.K., et al. (2017) The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery, 12: 29. DOI: 10.1186/s13017-017-0141-6
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