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Early versus delayed operation for acute cholecystitis

Identifieur interne : 003D94 ( Main/Exploration ); précédent : 003D93; suivant : 003D95

Early versus delayed operation for acute cholecystitis

Auteurs : W. Van Der Linden [Suède] ; H. Sunzel [Suède]

Source :

RBID : ISTEX:72FE2FE05B33B4A35CEBC033F32305F63C6614E9

Abstract

Patients with symptoms and signs of acute cholecystitis were randomly allocated to two treatment groups. One group was subjected to early surgery and the other was treated conservatively and operated on two months later. Six patients were not included in the trial, three because of peritonitis and three because of serious cardiac disorders. The diagnosis proved erroneous in seven cases. The final sample consisted of 140 patients, seventy in each treatment group. Twelve patients in the delayed operation group refused surgery whereas there were no refusals in the early operation group. In this latter group, operation was performed as a rule on the next routine operating list after the diagnosis was made, regardless of the duration of the attack. No difference was found in this group between patients operated on more than four days after the start of symptoms and those operated on earlier. Comparison of patients in the early and the deferred operation groups revealed more patients with prolonged fever and with a lengthy hospital stay in the latter group. In this group loss of working capacity lasted nearly 50 per cent longer. On the other hand, signs of low grade infection of the wound were found more often in the early operation group. Furthermore, with junior surgeons operating, the operations in this group lasted longer and provided more often technical difficulties. The findings are discussed and special attention is focused on the hazards of diagnostic errors. In the final evaluation early cholecystectomy performed by a surgeon thoroughly familiar with this operation is believed to be the treatment of choice.

Url:
DOI: 10.1016/S0002-9610(70)80133-7


Affiliations:


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<div type="abstract" xml:lang="en">Patients with symptoms and signs of acute cholecystitis were randomly allocated to two treatment groups. One group was subjected to early surgery and the other was treated conservatively and operated on two months later. Six patients were not included in the trial, three because of peritonitis and three because of serious cardiac disorders. The diagnosis proved erroneous in seven cases. The final sample consisted of 140 patients, seventy in each treatment group. Twelve patients in the delayed operation group refused surgery whereas there were no refusals in the early operation group. In this latter group, operation was performed as a rule on the next routine operating list after the diagnosis was made, regardless of the duration of the attack. No difference was found in this group between patients operated on more than four days after the start of symptoms and those operated on earlier. Comparison of patients in the early and the deferred operation groups revealed more patients with prolonged fever and with a lengthy hospital stay in the latter group. In this group loss of working capacity lasted nearly 50 per cent longer. On the other hand, signs of low grade infection of the wound were found more often in the early operation group. Furthermore, with junior surgeons operating, the operations in this group lasted longer and provided more often technical difficulties. The findings are discussed and special attention is focused on the hazards of diagnostic errors. In the final evaluation early cholecystectomy performed by a surgeon thoroughly familiar with this operation is believed to be the treatment of choice.</div>
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