Opciones terapéuticas para la colecistitis aguda: De las guías de Tokio 2018 a la práctica clínica

Sofía Mansilla; Santiago  Cubas; Marysol Martínez; Mario Almada; Fernando Machado; César  Canessa

doi:10.29193/RMU.38.3.6

Authors

Sofía Mansilla Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica B, Residente
Santiago Cubas Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica B, Profesor Adjunto
Marysol Martínez Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica B, Asistente
Mario Almada Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica B, Asistente
Fernando Machado Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Emergencia, Profesor
César Canessa Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica B, Profesor

DOI:

https://doi.org/10.29193/RMU.38.3.6

Keywords:

ACUTE CHOLECYSTITIS, LAPAROSCOPIC CHOLECYSTECTOMY, CHOLECYSTOSTOMY

Abstract

Introduction: early laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis. However, exclusive medical treatment (EMC) or medical treatment associated with percutaneous gallbladder drainage is the treatment of choice in elderly patients given their high surgical and anesthetic risk and upon the subacute course of the condition and/or its systemic repercussions.
Objective: to analyze and compare international guidelines to the therapeutic behavior for patients with acute cholecystectomy in two third-level hospitals.
Methodology: descriptive, prospective study of 161 patients with litiasic acute cholecystitis treated in the ER of Hospital de Clínicas and Hospital Español between May 2018 and May 2019.
Results: early laparoscopic cholecystectomy was indicated in 88% of patients, conversion being 3% and morbidity 9%. Twelve percent of patients received non-surgical treatment, 65% of which evidenced percutaneous cholecystostomy. Old age, comorbidities, dyscrasias, and severity of the condition were closely related to the therapeutic modality (p < 0.05). Forty percent of patients who received non-surgical treatment presented symptomatic repercussions. They all underwent delayed cholecystectomy.
Conclusions: early laparoscopic cholecystectomy is the most frequent treatment of choice. Unfavorable systemic characteristics are the main indications for non-surgical management in our country. This surgical treatment evidences high success rates and scarce morbidity with 40% of systemic repercussions.

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