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The efficacy of laparoscopic cholecystectomy without discontinuation in patients on antithrombotic therapy
Jong Hyuk Yun1, Hae Il Jung1, Hyoung Uk Lee1
1Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Insights
Emergent laparoscopic cholecystectomy (LC) for acute cholecystitis is safe without stopping antithrombotic therapy. While some patients experienced postoperative anemia, overall outcomes like hospital stay and mortality were similar to elective LC.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Safety
Background:
- Laparoscopic cholecystectomy (LC) is a common surgical procedure.
- There is no established consensus on performing LC in patients with acute cholecystitis who are on antithrombotic therapy.
- This study addresses the safety and outcomes of continuing antithrombotic therapy during emergent LC.
Purpose of the Study:
- To evaluate postoperative outcomes of patients undergoing emergent laparoscopic cholecystectomy (LC) for acute cholecystitis without interrupting antithrombotic therapy.
- To compare outcomes between emergent and elective LC in patients on antithrombotic therapy.
Main Methods:
- Retrospective review of 67 patients undergoing LC for acute cholecystitis from 2010-2015.
- Patients were categorized into emergent LC (n=22) and elective LC (n=45) groups.
- Analysis focused on postoperative outcomes, including anemia and transfusion rates.
Main Results:
- The emergent LC group had a shorter time from admission to operation and less antithrombotic drug discontinuation.
- Significantly more patients in the emergent group experienced postoperative anemia (6 vs. 0), with 3 requiring packed RBC transfusion.
- No significant differences were observed in postoperative length of stay, ICU stay, or mortality rates between the groups.
Conclusions:
- Emergent laparoscopic cholecystectomy (LC) can be performed safely and effectively without interrupting antithrombotic therapy.
- Further multicenter studies are recommended to confirm these findings and establish guidelines for antithrombotic management during LC.
Purpose:
Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries in the world today. However, there is no consensus regarding whether LC can be performed in patients with acute cholecystitis while on antithrombotic therapy. The objective of our study was to describe postoperative outcomes of patients who underwent emergent LC without interruption to antithrombotic therapy.
Methods:
We performed a retrospective review of patients who underwent LC for acute cholecystitis while on antithrombotic therapy from 2010 to 2015 at Soonchunhyang Universtiy Cheonan Hospital. Patients were divided into 2 groups as underwent emergent LC and elective LC.
Results:
A total of 67 patients (emergent group, 22; elective group, 45) were included in the analysis. Elective group had significantly longer duration between the admission and operation (8 [7-10] days vs. 2 [1-3] days, P < 0.001) and longer duration of antithrombotic drugs discontinuation (7 days vs. 1 [0-3] days, P < 0.001). Emergent group had significantly more postoperative anemia (6 patients vs. 0 patient, P = 0.001) and 3 of 6 patients received packed RBC transfusion in postoperative period. However, there was no significant difference in length of postoperative stays, length of intensive care unit stays and mortality rates.
Conclusion:
Emergent LC without interruption to antithrombotic therapy was relatively safe and useful. A well-designed multicenter study is needed to confirm the safety and efficacy of LC without suspension of antithrombotic therapy and to provide a simple guideline.
