A study to evaluate the optimal time for laparoscopic cholecystectomy after acute cholecystitis attack: a tertiary care centre study

Abstract

Background: Initially, laparoscopic cholecystectomy was contraindicated in patients with acute cholecystitis because of the fear of increased morbidity and high rates (60%) of conversion to open surgery. Nowadays, acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy but when to perform surgery still remains controversial. The purpose of this study is to find out whether laparoscopic cholecystectomy can be performed for acute cholecystitis irrespective of the time since onset of acute symptoms. Methods: A total of 100 laparoscopic cholecystectomies performed for acute cholecystitis were evaluated for duration of surgery, conversion rates, biliary and other organ injury, and postoperative stay by chi square test and paired t-tests using SPSS software. 45 patients underwent laparoscopic cholecystectomy within 48 h to seven days of onset of symptoms (group 1) and 55 patients underwent surgery after 6 weeks of onset of symptoms (group 2). Results: While the duration of surgery was comparable in both groups (56.5±15 vs. 45.5±15 min), there were no significant difference in conversions or major biliary or other organ injury in any of the two groups. Postoperative stay was also comparable between the two groups (4±1.5 vs 3±1.5, days) but total hospital stay was significantly reduced in group1 compared to group 2 (5±1.5 vs 8.5±1.5 days) and so as total cost is also reduced. Conclusions: Laparoscopic cholecystectomy can safely be performed at any time after the onset of acute cholecystitis. Early laparoscopic cholecystectomy has an outcome comparable to the delayed procedure, with a shorter total hospital stay and lower total costs, and it should be considered as the preferred approach in treatment of acute cholecystitis.

Evaluation of optimal time for laparoscopic cholecystectomy following acute cholecystitis attack in a tertiary care health centre

“…However, more studies are required for conclusive results. [2,3,5] The possible risk of severe complications and the high conversion rate of Laparoscopic cholecystectomy in the phase of acute inflammation is a main concern. [6,7] Later, as a result of increasing experience and confidence in Laparoscopic cholecystectomy and technical support, the suggestions of early Laparoscopic cholecystectomy were extended to include patients with acute cholecystitis.…”

“…The prevalence of cholelithiasis is between 10% and 15%, and roughly 35% of patients build up complications or recurrent symptoms in their life span. [3,4] Even though over 70% of acute cholecystitis reacts to medical treatment in the initial 24-48 hours, laparoscopic cholecystectomy is the perfect treatment of symptomatic gallstone disease and its complications [5] . The probable risk of severe complications and the high conversion rate of Laparoscopic cholecystectomy in period of acute inflammation is a chief concern [6,7] .…”