COVID-19 salgını döneminde akut kolesistit tedavisinde laparoskopi yerine perkütan kolesistostomi: Tek merkez deneyimi

AMAÇ: Laparoskopik kolesistektomi (LC), cerrahi için uygun hastalarda akut kolesistit (AC) için kabul edilen standart tedavidir. Perkütan kolesistostomi (PC), yüksek riskli hastalar için cerrahi için kalıcı bir tedavi sağlayabilir veya cerrahi tedavi için bir köprü görevi görebilir. PC’yi COVID-19 pandemisinde değerlendirdik. GEREÇ VE YÖNTEM: AC’li 50 hasta COVID-19 salgınının başlangıcından Haziran 2020’ye kadar kabul edildi. Pankreatit, kolanjit ve/veya eksik veriler çalışmadan çıkarıldı. Kalan 36 hastanın tümü kaydedildi ve tanımlayıcı istatistiksel analiz elde edildi. Hastalar üç gruba ayrıldı: PC (n=14); Sadece antibiyoterapi (OC) (n=14) ve LC (n=8) ile konservatif tedavi. BULGULAR: Ortalama yaş 53 (dağılım: 26–78 yıl) idi. Kadın/erkek oranı 1.11’dir. PC geçen yıl aynı dönemde sekiz (%11) hastada, pandemik dönemde 14 (%39) hastada tercih edildi. Otuz altı hastanın dördü COVID-19 için pozitifti ve bunlardan biri PC grubunda idi. PC grubunda kardiyak arrest nedeniyle bir (% 7.1) mortalite vardı. Gruplar arasında hastanede kalış süresi istatistiksel olarak anlamlı değildi. TARTIŞMA: Pandemi döneminde LC önerilmemektedir, bu nedenle PC AC tedavisinde etkili ve güvenli bir alternatif olabilir.

Abstract

BACKGROUND: Laparoscopic cholecystectomy (LC) is the accepted standard treatment for acute cholecystitis (AC) in patients eligible for surgery. Percutaneous cholecystostomy (PC) can provide a permanent treatment for high-risk patients for surgery or act as a bridge for later surgical treatment. This study is an evaluation of the use of PC during the current coronavirus 2019 (COVID-19) pandemic at a single hospital. METHODS: Fifty patients with AC were admitted as of the start of the COVID-19 pandemic in Turkey through June 2020. Patients with pancreatitis, cholangitis, and/or incomplete data were excluded from the study. Data of the remaining 36 patients included in the study were recorded and a descriptive statistical analysis was performed. The patients were divided into three groups: PC (n=14), only conservative treatment with antibiotherapy (OC) (n=14), and LC (n=8). The findings were compared with a group of 70 similar patients from the pre-pandemic period. RESULTS: The mean age of the pandemic period patients was 53 years (range: 26–78 years). The female/male ratio was 1.11. PC was preferred in eight (11%) patients in the same period of the previous year, whereas 14 (39%) patients underwent PC in the pandemic period. Four of the 36 pandemic patients were positive for COVID-19, including one member of the PC group. There was one (7.1%) mortality in the pandemic-period PC group due to cardiac arrest. The length of hospital stay between the groups based on the type of treatment was not statistically significant. CONCLUSION: LC is not recommended during the pandemic period; PC can be an effective and safe alternative for the treatment of AC.

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KOCATAŞ, A., SOMUNCU, E., KARA, Y., KIZILKAYA, M. C., BOZKURT, M. A., BOZDAĞ, E., YILDIZ, Z. B., ÖZKAN, C., ŞENER, A., GÖKAY, R., AYDIN, M. O. (2022). COVID-19 salgını döneminde akut kolesistit tedavisinde laparoskopi yerine perkütan kolesistostomi: Tek merkez deneyimi. Ulusal Travma ve Acil Cerrahi Dergisi, Cilt: 27 - Sayı: 1, 89–94. https://ajindex.com/articles/644085

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