Patients and methods
The current study completed at the General Surgery department, Banha University Hospital in Egypt and King Saud Hospital in Saudi Arabia since January 2015 till May 2017. The present study includes 100 patients with acute calculous cholecystitis. After approval of the study protocol by the Ethical Committee and obtaining fully informed written patients' consent for the participation in the study. Patients hospitalized through the emergency unit to the General Surgery department, high dependency unit (HDU) or intensive care unit (ICU) according to the seriousness of patients’ general condition at the time of admission.
Patients admitted for clinical, laboratory and radiological evaluation. Patients examined…show more content… Also, we excluded patients with gallbladder perforation or Mirizzi syndrome (preferred to do open cholecystectomy), Patients with gallbladder tumors or cholangitis (typically, to be managed conservatively first), and patients without complete data.
According to Tokyo Guidelines (TG13) , the severity assessment of ACC graded, grade I (mild): AC with mild GB inflammation with no organ dysfunction in a healthy patient, grade II (moderate): AC with one of the subsequent disorders: WBC count > 18 x109/L, tender mass in the right hypochondrium, onset of symptoms > 72 h, biliary peritonitis, pericholecystic abscess, liver abscess, gangrenous GB or emphysematous GB and grade III (Severe): AC associated with dysfunctions in one of the subsequent systems/organs: Neurological deterioration (diminished level of consciousness); cardiovascular impairment (hypotension necessitating dopamine 5 µg/kg/m, or any dose of dobutamine); renal impairment (creatinine > 2.0 mg/dl, oliguria); respiratory failure (PaO2/FiO2 ratio < 300); bone marrow dysfunction (platelet count < 100 x109/L)and hepatic function deterioration (INR > 1.5).
Preoperative assessment and preparation
On admission, all patients received intravenous broad spectrum antibiotic as soon as the diagnosis of ACC was established. When