The document discusses gallbladder pathology and cholecystectomy. It notes that 90% of cholecystectomies are now performed laparoscopically. For acute cholecystitis, early laparoscopic cholecystectomy within the first few days has lower conversion and complication rates than delayed surgery. The document also outlines criteria for diagnosing and classifying the severity of acute cholecystitis based on clinical signs, lab values, and imaging findings. Surgical management depends on the severity and includes laparoscopic cholecystectomy, drainage with possible delayed cholecystectomy, or open cholecystectomy for severe cases with organ dysfunction.

1. PATOLOGIA VESICULAR Dr. Roberto AvilaBaylón R3CG Hospital General de León.

2. Vesícula Biliar Primera Qx. John StougsBobbs. 15 julio colecistectomía. - 1882. Langenbuch. Anthony Eden, complicacón, 1953. Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

3. Vesicula Biliar 90% son laparoscopicas. Riesgosparaconversión : Mayor de 60 años Masculino. Más de 65 kgs. Si no se opera en los primeros 2 o 3 días de iniciar el evento, mejormanejo medico por 6 semanaspara resolver el cuadro. Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

4. Vesicula Biliar Cerca del 1% de VB se observa un carcinoma. En pacientes con cirrosis Del 7% a 26% de mortalidadparacolecistectomía. 1% de embarazos, desarrollacolelitiasis. 10-20% de morbilidad Pocentaje de conversión 1%. Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

5. Vesicula Biliar Criterios para colecistitis : Signos locales de inflamación, Murphy, masa palpable, dolor y escalosfrios, Signos sistemicos de inflamación : fiebre, elevación de PCR de 3, leucocitosis mas de 18 mil. Imagen, 1 de A o B J HepatobiliaryPancreatSurg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: TokyoGuidelines. MasahikoHirota

6. COLECISTITIS Datos ulsanograficos : Murphy sonografico, Pared mayor de 4 mm. VB de 8 cms de long., más de 4. Sensibilidad del 97%, especificidad 76%. J HepatobiliaryPancreatSurg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: TokyoGuidelines. MasahikoHirota

7. COLECISTITIS Clasificacion : LEVE, sin disfuncionorganica y cambio inflamatorios en VB. MODERADO, leucos de 18mil, masa palpable en CSD, duracion de 72 hrs de inicio del cuadro, liquido perivesicular. SEVERO. Cardiovascular, TA menor con aminas. Neurologico, deterior sin perdida del estado de alerta, Renal, oliguria o creatinina mayor de 2.0 Respiratoria con PaO2/FiO2 de menor de 300, Hepatica, Tp-INR 1.5 Hematologica. Plaquetas menor de 100 mil. J HepatobiliaryPancreatSurg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: TokyoGuidelines. MasahikoHirota

8. COLECISTITIS I. colecistectomialaparoscopica. II. Datos de inflamacion local drenaje más procedimiento quirurgico . III. Manejo urgente de la falla organica. drenaje más colecistectomía abierta. J HepatobiliaryPancreatSurg (2007) 14:91–97. Surgical treatment of patients with acute cholecystitis: TokyoGuidelines . YuichiYamashita

9. COLECISTITIS Table 4. Incidence of acute cholecystitis after endoscopic treatment of Choledocholithiasis CalculousgallbladderAcalculousgallbladderAverageobservationperiod(years) 5.8% (11/190) — 6.828a 7.6% (34/448) 1.2% (3/246) 7.529 12% (2/17) 0% (0/15) 14.530 22% (7/32) 1% (1/88) 10.231 a Whether or not the whole population had calculous gallbladders is unknown J HepatobiliaryPancreatSurg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: TokyoGuidelines. MasahikoHirota

10. COLECISTITIS Table 1. Comparisons of early and delayed laparoscopic cholecystectomy for acute cholecystitis Lengthof Lengthof ConversionConversionPostoperativePostoperative hospital stay hospital stay Number rate of rate of complications complications(days) Early (days) Delayed Author of patients early LC delayed LC of early LC of delayed LC surgery surgery Lo et al.5 86 11% 23% 13% 29% 6 11 Lai et al.6 91 21% 24% 9% 8% 7.6 11.6 Chandler et al.7 43 24% 36% 4% 9% 5.4 7.1 Johansson et al.15 143 31% 29% 18% 10% 5 8 LC, laparoscopic cholecystectomy; conversion rate, conversion rate to open surgery J HepatobiliaryPancreatSurg (2007) 14:91–97. Surgical treatment of patients with acute cholecystitis: TokyoGuidelines . YuichiYamashita

11. Vesicula Biliar Incision. Aponeurosis, Musculos Vesicula, Hepatocistico Calot Cierre por planos. Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

12. COLECISTECTOMIA Gracias……