A 72-Hour Boundary for Laparoscopic Cholecystectomy in Acute Cholecystitis Is Not Necessary: A Prospective Trial
Keywords:
Acute cholecystitis, laparoscopic cholecystectomy, cystic duct injury, conversion of laparoscopic cholecystectomy to open surgeryAbstract
Background: Laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) is currently considered safe, especially in settings where skilled and experienced surgeons are available, and if performed within the first 72 hours from the onset of inflammatory symptoms. Patients with symptoms persisting beyond 72 hours are often treated with antibiotics and undergo surgery by 6-8 weeks later.
Objective: To compare clinical outcomes between patients who underwent early LC within 24 to 72 hours and those who underwent late LC beyond 72 hours, from the onset of inflammatory symptoms of AC.
Methodology: A prospective data collection of consecutive AC patients undergoing LC during the study period at Saraburi Hospital.
Result: Data was collected during 1 January 2014 and 31 July 2015. There were 71 patients, of whom 35 received early LC (49%) and 36 underwent late LC (51%). According to TG13-severity grading, we found more patients with moderate severity (TG13, grade II) in the early LC group than in the late LC group. There was a higher number of gangrenous gallbladders and mucosal necrosis in the early LC group, while in the late LC group there was a higher incidence of thickened gallbladder wall (> 5 millimeters) and uncertain anatomy of cystic duct-common bile duct (CBD) junctions. There were no differences regarding operating time, incidence of complications, especially as a result from bile duct injury, conversion to open surgery, length of hospital stay and hospital deaths, between the two groups.
Conclusion: LC for AC beyond 72 hours is feasible and safe in the setting where skilled and experienced laparoscopic surgeons are available.
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