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. 2012 Aug 21:12:113.
doi: 10.1186/1471-230X-12-113.

Cholecystomucoclasis: revaluation of safety and validity in aged populations

Tomoya Tsukada  1 , Tatsuo Nakano, Takashi Miyata, Shozo Sasaki, Tetsuo Ohta
Affiliations

Cholecystomucoclasis: revaluation of safety and validity in aged populations

Tomoya Tsukada et al. BMC Gastroenterol. .

Abstract

Background: We evaluated the safety and validity of cholecystomucoclasis (CM) and compared its intraoperative characteristics with those of standard cholecystectomy (SC).

Methods: We enrolled 174 patients who underwent cholecystectomy and retrospectively evaluated the outcomes of patients in the SC and CM groups.

Results: Significant differences in age (71.1 vs. 61.9 years), American Society of Anesthesiologists physical status (ASA-PS), and serum C-reactive protein levels (CRP) (18.1 vs. 4.7 mg/dL) were observed between the CM and SC groups. Conversely, no significant differences were observed in the operation time (129 vs. 108 min), amount of blood loss (147 vs. 80 mL), intraoperative complications (0% vs. 5.7%), or duration of hospital stay (13.2 vs. 8.9 days) between the 2 groups. A high conversion rate (35.3%), postoperative complications (33%), and frequent drain insertions (94%) were observed in the CM group.

Conclusions: CM is a safe and valid surgical procedure and surgeons should not hesitate to transition to CM for patients who are of advanced age, in poor general condition (high ASA classification), or have high levels of serum CRP.

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Figures

Figure 1
Figure 1
Representative intraoperative findings of cholecystomucoclasis for acute cholecystitis. a: Overview of acute cholecystitis. b: Double-clipped cystic artery (arrowhead). c: The gallbladder was incised carefully because of the lack of a clear indication of the correct layer. d: The gallbladder mucosa cauterized by electrocautery (arrowhead).
Figure 2
Figure 2
Representative intraoperative findings of cholecystomucoclasis for atrophic cholecystitis. a: Overview of atrophic gallbladder in chronic cholecystitis. b: Injury of the gallbladder body wall while dissecting from the liver bed. The gallbladder mucosa and gallstones were exposed (arrowhead). c: The gallbladder was incised consecutively from the site of the exposed gallbladder mucosa. d: Overview after gallbladder removal showing the residual gallbladder posterior wall (arrowhead).
Figure 3
Figure 3
Detailed analysis of the severe intraoperative complications resulting from cholecystectomy.
See this image and copyright information in PMC

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