Una revisión de la colecistitis aguda
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Jared R Gallaher1, Anthony Charles1
1Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill.
JAMA
|March 8, 2022
Resumen
La colecistectomía laparoscópica temprana es el tratamiento recomendado para la colecistitis aguda, mejorando significativamente los resultados del paciente y reduciendo las complicaciones. Este enfoque quirúrgico oportuno ofrece mejores resultados en comparación con el tratamiento retrasado para varios grupos de pacientes.
Área de la Ciencia:
- Gastroenterología
- Innovación quirúrgica
- Imágenes de diagnóstico
Sus antecedentes:
- La colecistitis aguda afecta a 200.000 personas anualmente en los Estados Unidos, a menudo causada por una obstrucción de cálculos biliares.
- La colecistitis acálculo ocurre en el 5-10% de los casos, típicamente en pacientes en estado crítico.
- Los síntomas clásicos incluyen dolor en el cuadrante superior derecho, fiebre y náuseas.
Objetivo del estudio:
- Evaluar la eficacia de la colecistectomía laparoscópica temprana frente al tratamiento retrasado de la colecistitis aguda.
- Evaluar los resultados en poblaciones específicas, incluidas mujeres embarazadas y pacientes de edad avanzada.
- Para comparar la colecistostomía percutánea con la colecistectomía laparoscópica en pacientes de alto riesgo.
Principales métodos:
- El diagnóstico fue confirmado por ultrasonografía y cintigrafía hepatobiliar.
- Análisis de los resultados de los pacientes basados en el momento de la colecistectomía laparoscópica (temprano vs. tarde).
- Comparación de los resultados de la colecistostomía percutánea con la colecistectomía laparoscópica.
Principales resultados:
- La colecistectomía laparoscópica temprana (1-3 días) mostró menos complicaciones (11,8% frente a 34,4%), estancias hospitalarias más cortas (5,4 frente a 10,0 días) y costos más bajos.
- En el embarazo, la cirugía temprana redujo las complicaciones materno-fetal (1,6% frente a 18,4%).
- En los pacientes mayores de 65 años, la cirugía temprana redujo la mortalidad a los 2 años (15,2% frente a 29,3%). El drenaje percutáneo tuvo mayores tasas de complicaciones (65% frente al 12%).
Conclusiones:
- La colecistectomía laparoscópica temprana es el tratamiento preferido para la colecistitis aguda, que ofrece resultados superiores.
- La intervención oportuna es crucial para diversos grupos demográficos de pacientes, incluidas las mujeres embarazadas y los ancianos.
- La colecistostomía percutánea es una medida temporal solo para pacientes críticos.
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