The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital

Surgical management of acute cholecystitis

“…In the RCT by Gutt et al [19], the group of patients (n=314) operated on at days 7 to 45 after hospital admission had no difference in conversion rates when compared to patients undergoing cholecystectomy within 24 h. However, it needs to be emphasised that this trial was performed in a tertiary unit where the surgeons would have the experience and expertise to operate on difficult cases. However, in a retrospective review [36] of 202 patients, there were no differences in conversion rate or complication rates in patients who underwent cholecystectomy between 4 days and 5 weeks of onset of symptoms, as compared to those who underwent surgery within 72 h or beyond 5 weeks. In other retrospective reviews, patients who underwent cholecystectomy between 3 and 10 days [46], 4 and 21 days [47], 4 and 8 days [48] and 4 days and 6 weeks [41] after onset of symptoms or hospital admission did not have increased morbidity, mortality or conversion rate when compared to patients who underwent surgery within 72 h. Another retrospective review [49] found that the conversion rate to open cholecystectomy increased from 10 % in patients operated on within 2 days of onset of symptoms to 16 % in those operated on 3-4 days to 39 % for those operated on 5 days or more after onset of symptoms.…”

“…Proponents also claim that an early cholecystectomy may reduce hospital stay and prevent readmissions to hospital. Surgical teaching has been that laparoscopic cholecystectomy can be undertaken successfully within 72 h of onset of symptoms and, beyond this period, operative difficulty increases [36]. However, there is no consensus on the optimal timing of early laparoscopic cholecystectomy.…”

“…These results may not, therefore, be applicable to all surgical units. Some recent retrospective analyses, although limited by their retrospective study design and small cohort sizes, have shown that cholecystectomy during the initial admission but beyond the initial 72-h period from onset of symptoms is safe and without added risk of conversion or complications [36,40,41].…”

“…Some consider this period to be from the onset of patient's symptoms, and others consider it to begin from the time of hospital admission. Traditional surgical teaching has been that cholecystectomy, if considered for acute cholecystitis, should be performed within a 72-h period [36]. This so-called golden period has been a general trend followed by many surgeons, rather than a recommendation or evidence-based guideline.…”

Single center retrospective analysis of early vs. delayed treatment in acute calcolous cholecystitis: application of a clinical pathway and an economic analysis

“…Indeed, in a meta-analysis recognizing the superiority of early surgery, the time limit is variable from 48 h to seven days [12] and recent evidence has not shown clinical advantage with this strict temporal limit. [24][25][26] One question rises looking at the gap between clinical and economic advantages of index cholecystectomy for AAC and the "reluctance" to apply ELC: why? One reason could be still related to the surgeon fair for an anecdotal belief of higher common bile duct injury and higher conversion rate in the acute setting.…”