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Colecistitis aguda: manejo percutáneo vs. quirúrgico, abordando el sesgo de selección en meta-análisis
1Department of Acute Care Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. chen.ling3@zs-hospital.sh.cn.
World journal of emergency surgery : WJES
|February 14, 2026
Resumen
La colecistectomía (CC) muestra mejores resultados que la colecistocistostomía percutánea (PC) para la colecistitis aguda. Sin embargo, la PC se utiliza para pacientes de alto riesgo, lo que significa que los resultados reflejan el riesgo de base, no solo la eficacia del tratamiento.
Área de la Ciencia:
- Gastroenterología
- Innovación Quirúrgica
- Medicina de Emergencia
Sus antecedentes:
- El manejo de la colecistitis aguda incluye la colecistectomía (CC) y la colecistocistostomía percutánea (PC).
- Una revisión sistemática reciente comparó los resultados entre la CC y la PC.
- La PC es a menudo una medida temporal para pacientes de alto riesgo.
Objetivo del estudio:
- Evaluar críticamente una revisión sistemática que compara la CC y la PC para la colecistitis aguda.
- Destacar el impacto del sesgo de selección de pacientes en los resultados reportados.
- Aclarar las funciones de la CC y la PC en el manejo de la colecistitis aguda.
Principales métodos:
- Revisión sistemática y meta-análisis de estudios que comparan CC y PC.
- Comentario que analiza los hallazgos en el contexto de la práctica clínica.
- Evaluación del sesgo de selección en la asignación de pacientes.
Principales resultados:
- La colecistectomía (CC), especialmente la laparoscópica, se asocia con menores tasas de mortalidad y reingreso que la colecistocistostomía percutánea (PC).
- Las diferencias observadas en los resultados se deben en parte a que la PC se utiliza en pacientes de mayor riesgo y no candidatos a cirugía.
- El sesgo de selección influye significativamente en la interpretación de la efectividad comparativa.
Conclusiones:
- La colecistectomía temprana sigue siendo el estándar de atención para los pacientes elegibles con colecistitis aguda.
- La colecistocistostomía percutánea sirve como una valiosa "terapia puente" para la estabilización del paciente.
- La investigación futura debe refinar la estratificación del riesgo y optimizar el momento de la CC tardía después de la PC.
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