Delay from Symptom Onset Increases the Conversion Rate in Laparoscopic Cholecystectomy for Acute Cholecystitis

Abstract

Background Randomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate. Methods We performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis. Results Of patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0-2 days, 3-4 days, 5-6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions. Conclusions Early intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.The abstract was presented at

Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis

“…Conversion rates ranging from under 5%e30% have been reported. The predictors of the need for conversion include a duration of symptoms of more than a range of 72e96 h [44,45], a white-cell count of more than 18,000 cells/sqmm at the time of presentation [44,48,49] and an age over 60 years [44,46,47]. In the present study the average conversion rate was of 20.87% but without a high rate of bile duct injuries.…”

Population-Based Analysis of 4113 Patients With Acute Cholecystitis

“…[18][19][20] Larger cohort studies with lower conversion rates of less than 10% also include LC done in an elective setting, 21 with elective surgery for the noninflamed gallbladder inevitably resulting in lower conversion rates. 20 These patients will therefore benefit from all the advantages of a laparoscopic intervention, including less postoperative pain, shorter return to normal activities, and reduced blood loss.…”

“…[18][19][20] Larger cohort studies with lower conversion rates of less than 10% also include LC done in an elective setting, 21 with elective surgery for the noninflamed gallbladder inevitably resulting in lower conversion rates. 20 These patients will therefore benefit from all the advantages of a laparoscopic intervention, including less postoperative pain, shorter return to normal activities, and reduced blood loss. 22,23 More recent studies support our findings, as they also fail to show an increase in conversion rate for early LC as opposed to delayed (>6-8 weeks) surgery 18 and certain authors even show more favorable results for early surgery.…”

Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates

“…Moreover, the definition of early operation has ranged from 2 to 4 days [13][14][15][16][17] from admission. A study by Hadad et al [18] specifically looked at timing in relation to symptom onset and concluded that delay from the onset of symptoms increases the risk of conversion. We addressed the effect of both variables of time in this study.…”