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Outcome Analysis of Conservative Management of Acute Calculus Cholecystitis in Addis Ababa University Teaching Hospitals Addis Ababa, Ethiopia: Retrospective Study

Received: 9 January 2023     Accepted: 3 July 2023     Published: 11 July 2023
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Abstract

Back ground: cholecystectomy for an acutely inflamed gall bladder is accompanied with significant perioperative complications Conservative (non operative management) is considered to be the standard of care mainly in the developed world. Non operative management is still widely practiced in many developing countries including Ethiopia. This study aimed to assess the outcome of such a conservative management in teaching hospitals Addis Ababa, Ethiopia. Method: Hospital based cross-sectional study design was conducted. Data was entered and analyzed by SPSS version 20. Chi-square, binary logistic regression, at 95% CI and P-value <0.05 were used to examine relationship between dependent and independent variables. Results: A total of 134 cases were admitted. In this study the mean age is 41.67, (95% CI 39.5 to 43.9) and M: F ratio is 1:2.2 and Age of the patients ranged between 15-80 years and majority of them were in the age group of 35-44 (32.1%) years. Conservative treatment during index admission was successful in 96.27% of the cases but mean duration of hospital stay 5.54 days, 95% CI (5.03, 6.05). Duration of illness before (OR = 3.47: 1.26-9.55) and Duration of hospital stay (OR = 1.92: 1.28-2.87) were determinant factors for index admission. 19% of patients encountered complication while waiting for cholecystectomy. Comorbidity (AOR = 4.06: 1.49 - 11.07; value = 0.006). GB stone impacted at the neck (AOR = 3.39: (1.259-9.13); value = 0.016) were associated factors identified. In this study out of 131 cases treated and discharged improved and appointed for interval- cholecystectomy only 71.7% of them had interval -cholecystectomy in two-year period. The rest 13 (9.7%) patients did not show up follow up after admission booked (registered under waiting list for bed). 3 patients died with complications directly or indirectly related to conservative management cholecystitis. Conclusion and Recommendations: this study revealed patients arrival to hospital is delayed and also stayed prolonged time in the hospital. significant number of patients also developed complications while waiting for interval cholecystectomy and also significant Number of patients did not get cholecystectomy service. Nationwide introduction of emergency laparoscopic cholecystectomy and Patient referral system, admission, discharge and follow up system needs revision.

Published in American Journal of Clinical and Experimental Medicine (Volume 11, Issue 3)
DOI 10.11648/j.ajcem.20231103.13
Page(s) 58-65
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Conservative Management, Acute Cholecystitis, Elective Cholecystectomy Duration of Hospital Stay

References
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[2] Serralta, a. S., bueno, j. L., planells, m. R., & rodero, d. R. (2003). Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. Surgical laparoscopy, endoscopy and percutaneous techniques, 13 (2), 71–75. Https://doi.org/10.1097/00129689-200304000-00002
[3] Saeed, s. A., & masroor, i. (2010). Percutaneous cholecystostomy (pc) in the management of acute cholecystitis in high risk patients. Journal of the college of physicians and surgeons pakistan, 20 (9), 612–615. Https://doi.org/09.2010/jcpsp.612615
[4] Yamashita, y., takada, t., kawarada, y., nimura, y., hirota, m., miura, f., … sachakul, v. (2007). Surgical treatment of patients with acute cholecystitis: tokyo guidelines. Journal of hepato-biliary-pancreatic surgery, 14 (1), 91–97. Https://doi.org/10.1007/s00534-006-1161-x
[5] Getachew, a. (2006). Epidemiology of gallstone disease in gondar university hospital, as seen in the department of radiology, (september 2004).
[6] Forssmann, k., & singer, m. V. (1994). [acute cholecystitis--conservative therapy]. Schweizerische rundschau fur medizin praxis, 83 (32), 877–879. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?t=js&csc=y&news=n&page=fulltext&d=med3&an=8091058
[7] %Yokoe, m., takada, t., strasberg, s. M., solomkin, j. S., mayumi, t., gomi, h., … ker, c. G. (2013). Tg13 diagnostic criteria and severity grading of acute cholecystitis (with videos). Journal of hepato-biliary-pancreatic sciences, 20 (1), 35–46. Https://doi.org/10.1007/s00534-012-0568-9
[8] Komatsu, s., tsuchida, s., wakahara, t., ueno, n., toyokawa, a., watanabe, a., mukai, h. (2017). Outcomes of consistent conservative management for acute cholecystitis followed by delayed cholecystectomy. Surgical laparoscopy, endoscopy and percutaneous techniques, 27 (5), 404–408. Https://doi.org/10.1097/sle.0000000000000458
[9] Miura, f., okamoto, k., takada, t., strasberg, s. M., asbun, h. J., & pitt, h. A. (2018). Tokyo guidelines 2018 : initial management of acute biliary infection and fl owchart for acute cholangitis, 31–40. Https://doi.org/10.1002/jhbp.509
[10] Elwood, d. R. (2008). Cholecystitis. Surgical clinics of north america. Https://doi.org/10.1016/j.suc.2008.07.008
[11] Knab, l. M., boller, a.-m., & mahvi, d. M. (2014). Cholecystitis. Surgical clinics of north america, 94 (2), 455–470. Https://doi.org/10.1016/j.suc.2014.01.005
[12] Yusoff, i. F., barkun, j. S., & barkun, a. N. (2003). Diagnosis and management of cholecystitis and cholangitis. Gastroenterology clinics of north america. Https://doi.org/10.1016/s0889-8553(03)00090-6
[13] Hirota, m., takada, t., kawarada, y., nimura, y., miura, f., hirata, k.,… dervenis, c. (2007). Diagnostic criteria and severity assessment of acute cholecystitis: tokyo guidelines. Journal of hepato-biliary-pancreatic surgery, 14 (1), 78–82. Https://doi.org/10.1007/s00534-006-1159-4
[14] L. m., k., a.-m., b., & d. m., m. (2014). Cholecystitis. Surgical clinics of north america, 94 (2), 455–470. Retrieved from http://www.elsevier.com/inca/publications/store/6/2/3/1/9/6/index.htt%5cnhttp://ovidsp.ovid.com/ovidweb.cgi?t=js&page=reference&d=emed12&news=n&an=2014217577%5cnhttp://ovidsp.ovid.com/ovidweb.cgi?t=js&page=reference&d=medl&news=n&an=24679431
[15] Soumitra r. Eachempati, m. d., f. a. c. s., f. c. c. m. (2015). Acute cholecystitis. New york: springler.
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    Belete Shekuro, Paulos Jaleta Wondasho, Henok Seife, Nebiyu Seyoum, Sahlu Wondimu. (2023). Outcome Analysis of Conservative Management of Acute Calculus Cholecystitis in Addis Ababa University Teaching Hospitals Addis Ababa, Ethiopia: Retrospective Study. American Journal of Clinical and Experimental Medicine, 11(3), 58-65. https://doi.org/10.11648/j.ajcem.20231103.13

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    Belete Shekuro; Paulos Jaleta Wondasho; Henok Seife; Nebiyu Seyoum; Sahlu Wondimu. Outcome Analysis of Conservative Management of Acute Calculus Cholecystitis in Addis Ababa University Teaching Hospitals Addis Ababa, Ethiopia: Retrospective Study. Am. J. Clin. Exp. Med. 2023, 11(3), 58-65. doi: 10.11648/j.ajcem.20231103.13

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    AMA Style

    Belete Shekuro, Paulos Jaleta Wondasho, Henok Seife, Nebiyu Seyoum, Sahlu Wondimu. Outcome Analysis of Conservative Management of Acute Calculus Cholecystitis in Addis Ababa University Teaching Hospitals Addis Ababa, Ethiopia: Retrospective Study. Am J Clin Exp Med. 2023;11(3):58-65. doi: 10.11648/j.ajcem.20231103.13

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  • @article{10.11648/j.ajcem.20231103.13,
      author = {Belete Shekuro and Paulos Jaleta Wondasho and Henok Seife and Nebiyu Seyoum and Sahlu Wondimu},
      title = {Outcome Analysis of Conservative Management of Acute Calculus Cholecystitis in Addis Ababa University Teaching Hospitals Addis Ababa, Ethiopia: Retrospective Study},
      journal = {American Journal of Clinical and Experimental Medicine},
      volume = {11},
      number = {3},
      pages = {58-65},
      doi = {10.11648/j.ajcem.20231103.13},
      url = {https://doi.org/10.11648/j.ajcem.20231103.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcem.20231103.13},
      abstract = {Back ground: cholecystectomy for an acutely inflamed gall bladder is accompanied with significant perioperative complications Conservative (non operative management) is considered to be the standard of care mainly in the developed world. Non operative management is still widely practiced in many developing countries including Ethiopia. This study aimed to assess the outcome of such a conservative management in teaching hospitals Addis Ababa, Ethiopia. Method: Hospital based cross-sectional study design was conducted. Data was entered and analyzed by SPSS version 20. Chi-square, binary logistic regression, at 95% CI and P-value Results: A total of 134 cases were admitted. In this study the mean age is 41.67, (95% CI 39.5 to 43.9) and M: F ratio is 1:2.2 and Age of the patients ranged between 15-80 years and majority of them were in the age group of 35-44 (32.1%) years. Conservative treatment during index admission was successful in 96.27% of the cases but mean duration of hospital stay 5.54 days, 95% CI (5.03, 6.05). Duration of illness before (OR = 3.47: 1.26-9.55) and Duration of hospital stay (OR = 1.92: 1.28-2.87) were determinant factors for index admission. 19% of patients encountered complication while waiting for cholecystectomy. Comorbidity (AOR = 4.06: 1.49 - 11.07; value = 0.006). GB stone impacted at the neck (AOR = 3.39: (1.259-9.13); value = 0.016) were associated factors identified. In this study out of 131 cases treated and discharged improved and appointed for interval- cholecystectomy only 71.7% of them had interval -cholecystectomy in two-year period. The rest 13 (9.7%) patients did not show up follow up after admission booked (registered under waiting list for bed). 3 patients died with complications directly or indirectly related to conservative management cholecystitis. Conclusion and Recommendations: this study revealed patients arrival to hospital is delayed and also stayed prolonged time in the hospital. significant number of patients also developed complications while waiting for interval cholecystectomy and also significant Number of patients did not get cholecystectomy service. Nationwide introduction of emergency laparoscopic cholecystectomy and Patient referral system, admission, discharge and follow up system needs revision.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Outcome Analysis of Conservative Management of Acute Calculus Cholecystitis in Addis Ababa University Teaching Hospitals Addis Ababa, Ethiopia: Retrospective Study
    AU  - Belete Shekuro
    AU  - Paulos Jaleta Wondasho
    AU  - Henok Seife
    AU  - Nebiyu Seyoum
    AU  - Sahlu Wondimu
    Y1  - 2023/07/11
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ajcem.20231103.13
    DO  - 10.11648/j.ajcem.20231103.13
    T2  - American Journal of Clinical and Experimental Medicine
    JF  - American Journal of Clinical and Experimental Medicine
    JO  - American Journal of Clinical and Experimental Medicine
    SP  - 58
    EP  - 65
    PB  - Science Publishing Group
    SN  - 2330-8133
    UR  - https://doi.org/10.11648/j.ajcem.20231103.13
    AB  - Back ground: cholecystectomy for an acutely inflamed gall bladder is accompanied with significant perioperative complications Conservative (non operative management) is considered to be the standard of care mainly in the developed world. Non operative management is still widely practiced in many developing countries including Ethiopia. This study aimed to assess the outcome of such a conservative management in teaching hospitals Addis Ababa, Ethiopia. Method: Hospital based cross-sectional study design was conducted. Data was entered and analyzed by SPSS version 20. Chi-square, binary logistic regression, at 95% CI and P-value Results: A total of 134 cases were admitted. In this study the mean age is 41.67, (95% CI 39.5 to 43.9) and M: F ratio is 1:2.2 and Age of the patients ranged between 15-80 years and majority of them were in the age group of 35-44 (32.1%) years. Conservative treatment during index admission was successful in 96.27% of the cases but mean duration of hospital stay 5.54 days, 95% CI (5.03, 6.05). Duration of illness before (OR = 3.47: 1.26-9.55) and Duration of hospital stay (OR = 1.92: 1.28-2.87) were determinant factors for index admission. 19% of patients encountered complication while waiting for cholecystectomy. Comorbidity (AOR = 4.06: 1.49 - 11.07; value = 0.006). GB stone impacted at the neck (AOR = 3.39: (1.259-9.13); value = 0.016) were associated factors identified. In this study out of 131 cases treated and discharged improved and appointed for interval- cholecystectomy only 71.7% of them had interval -cholecystectomy in two-year period. The rest 13 (9.7%) patients did not show up follow up after admission booked (registered under waiting list for bed). 3 patients died with complications directly or indirectly related to conservative management cholecystitis. Conclusion and Recommendations: this study revealed patients arrival to hospital is delayed and also stayed prolonged time in the hospital. significant number of patients also developed complications while waiting for interval cholecystectomy and also significant Number of patients did not get cholecystectomy service. Nationwide introduction of emergency laparoscopic cholecystectomy and Patient referral system, admission, discharge and follow up system needs revision.
    VL  - 11
    IS  - 3
    ER  - 

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Author Information
  • Department of Public Health, Health Science College, Assosa University, Assosa, Ethiopia

  • Department of Nursing, Health Science College, Assosa University, Assosa, Ethiopia

  • Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia

  • Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia

  • Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia

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