Timing of laparoscopic cholecystectomy in acute cholecystitis

Abstract

Early laparoscopic cholecystectomy is the treatment of choice for acute cholecystitis, but is associated with a high conversion rate independent of the timing of surgery.

Is there an optimal time for laparoscopic cholecystectomy in acute cholecystitis?

“…Our results show that, even in a teaching hospital, conversion rates are relatively higher in elective cases (8.8%-16.5%), but still We chose to use the day of admission as a reference for time measurement instead of the first day of symptoms. Eldar and colleagues used the first day of symptoms as a reference and found higher conversion rates (39%), but no increase in complication rates with delays of more than 48 h, and this finding was supported by others [5,7,18]. Onset of symptoms is a subjective parameter, and therefore in many hospitals it is the day of admission and the initiation of conservative treatment that is the main guide to operative scheduling [2].…”

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

“…Moreover, the definition of early operation has ranged from 2 days [16], 3 days [17], to 4 days [18] from onset of symptoms. Others suggest that a high conversion rate for emergency laparoscopic cholecystectomy is independent of the timing of surgery [19,20].…”

Role of Laproscopic Cholecystectomy in the Management of Acute Cholecystitis

“…In our study, 106(21.9% ) patients presented with acute cholecystitis. But in a study by Cheema, 120 out of 132 (90.91%) cases of cholelithiasis were in acute cholecystitis 9 while Ludwig et al 10 and Serratic et al 6 have reported 71.9% and 41.84% cases respectively in acute phase. In our study, the maximum number of patients was operated within 24 hours while a study by Johansson has reported that early laparoscopic cholecystectomy may be carried out within 7 days of onset of symptoms 11 .…”

“…Per-operative complications in this study included bleeding in 11(10.3%) cases, CBD injury in 5(4.71%), minor injury to liver in 5(4.71% ) and distorted anatomy of Calot's triangle in 10 (9.43% ) cases respectively. Meanwhile, in Cheema's study, 3 bile duct injuries have been reported among 482 cases 9 . However, early recognition and prompt repair gives good results 18 .…”