title: Verification of our therapeutic criterion for acute cholecystitis: "perform a subemergency laparoscopic cholecystectomy when a patient is judged to be able to tolerate general anesthesia"--the experience in a single community hospital.
abstract: BACKGROUND
  Our current therapeutic criterion for acute cholecystitis is: Perform a subemergency laparoscopic cholecystectomy (LC) when a patient is judged to be able to tolerate general anesthesia. The aim of the current study was to verify whether this criterion is justified.
  
  
  METHODS
  The outcomes of 21 cases of LC for acute cholecystitis performed between April 2011 and September 2013 were retrospectively analyzed. Subemergency LC was performed according to the aforementioned criterion (Subemergency group; n = 16). Patient who was judged to be unable to tolerate general anesthesia underwent percutaneous transhepatic gallbladder drainage (PTGBD) first, then LC after the patients' condition became stable (PTGBD group; n = 5).
  
  
  RESULTS
  There is no conversion to open surgery throughout the study period. The mean of the total hospital stays in the Subemergency group was significantly shorter than that in the PTGBD group (11.5 +/- 5.3 vs. 30.4 +/- 8.5 days). Although two patients in the Subemergency group, who had already needed oxygen administration preoperatively, suffered postoperative respiratory failure, they completely recovered. On the other hand, there is no postoperative complication in the PTGBD group.
  
  
  CONCLUSIONS
  Subemergency LC could be safely performed when surgeons as well as anesthesiologists judged a patient to be able to tolerate general anesthesia, which significantly shorten hospital stays compared to elective LC after PTGBD. However, elective LC after PTGBD is an absolutely safer therapeutic option in treating unstable patients.
authors: Department of Surgery, Fukuoka City Hospital, Japan. huchi@surg2.med.kyushu-u.ac.jp
authors: Hideaki
authors: H
authors: Uchiyama
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Ken
authors: K
authors: Shirabe
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Tomoharu
authors: T
authors: Yoshizumi
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Toru
authors: T
authors: Ikegami
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Yuji
authors: Y
authors: Soejima
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Tetsuo
authors: T
authors: Ikeda
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Hirofumi
authors: H
authors: Kawanaka
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Yo-Ichi
authors: Y
authors: Yamashita
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Masaru
authors: M
authors: Morita
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Eiji
authors: E
authors: Oki
authors: Department of Surgery, Kyushu University Beppu Hospital, Japan.
authors: Koushi
authors: K
authors: Mimori
authors: Department of Surgery, Kyushu University Beppu Hospital, Japan.
authors: Keishi
authors: K
authors: Sugimachi
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Hiroshi
authors: H
authors: Saeki
authors: Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Japan.
authors: Masayuki
authors: M
authors: Watanabe
authors: Department of Surgery, Fukuoka City Hospital, Japan.
authors: Kenji
authors: K
authors: Takenaka
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005704:Gallbladder; D006764:Hospitals, Community; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome