Document Detail

[Analysis of the most appropriate surgical treatment for acute cholecystitis by applying the RAND/UCLA method].
MedLine Citation:
PMID:  22771292     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Acute cholecystitis (AC) is a common indication for cholecystectomy. Local circumstances and certain patient characteristics lead to high failure rates and complications in laparoscopic cholecystectomy (LC), and despite the experience gained, we still do not have a detailed list of indications which could minimise them.
MATERIAL AND METHOD: We used the RAND/UCLA Appropriateness Method (RAM) to evaluate 2 options, LC and open cholecystectomy (OC). An expert panel analysed its suitability after a literature review, a consensus meeting, and 2 rounds of scores on different clinical situations. The score of each scenario was analysed to establish the appropriateness level of each option.
RESULTS: At the end of the meeting there were 64 defined scenarios, with an agreement being reached on the indications in 67.18% of them. In 86.04% of the scenarios, the agreement was due to the appropriateness of the indications. When cholecystectomy was indicated, it was always by laparoscopy, while it was only occasionally by laparotomy. In patients with less than 72 h of onset, LC was always considered appropriate when there was sepsis, or even without this if the ultrasound data showed complicated AC.
CONCLUSIONS: There is still uncertainty as regards the management of AC, especially as regards the timing of the operation and the surgical approach, particularly in frail patients and with a clinical onset greater than 72 h. The RAND method can help to make decisions on the appropriateness of different therapeutic options.
Daniel Díaz-Gómez; Pablo Parra-Membrives; Román Villegas-Portero; Máximo Molina-Linde; Lourdes Gómez-Bujedo; Juan Ramón Lacalle-Remigio
Publication Detail:
Type:  English Abstract; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-07-06
Journal Detail:
Title:  Cirugía española     Volume:  90     ISSN:  1578-147X     ISO Abbreviation:  Cir Esp     Publication Date:    2012 Aug-Sep
Date Detail:
Created Date:  2012-09-04     Completed Date:  2013-01-28     Revised Date:  2013-09-30    
Medline Journal Info:
Nlm Unique ID:  1254104     Medline TA:  Cir Esp     Country:  Spain    
Other Details:
Languages:  spa     Pagination:  453-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.
Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Valme, Sevilla, España.
Vernacular Title:
Análisis del tratamiento quirúrgico más apropiado para la colecistitis aguda mediante aplicación del método RAND/UCLA.
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MeSH Terms
Cholecystectomy, Laparoscopic
Cholecystitis, Acute / surgery*
Delphi Technique
Comment In:
Cir Esp. 2013 Aug-Sep;91(7):469-70   [PMID:  23827928 ]

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