Early versus delayed laparoscopic cholecystectomy in treatment of acute cholecystitis

Abstract

BACKGROUND: Acute cholecystitis is one of the most frequent diseases occurring in the developed countries of the world. Since the advent of laparoscopic cholecystectomy there has been a lack of agreement regarding the timing of the operation in the treatment of acute cholecystitis. METHODS: From September 2012 to January 2015 we carried out a prospective randomized trial at the IIIrd Surgical Department of University Hospital Milosrdní bratia in Bratislava. The aim of the trial was to compare the two basic approaches of the treatment of acute cholecystitis. During our trial, 62 patients with acute cholecystitis were admitted to the surgery department and 31 patients were treated with an early laparoscopic cholecystectomy within 72 hours after the appearance of the symptoms. Other 31 patients were primarily treated with antibiotics and subsequently underwent a delayed cholecystectomy after 6-8 weeks. RESULTS: Our results suggest several advantages of the early laparoscopic cholecystectomy such as shorter operation time, lower conversion rate, shorter length of hospital stay, shorter postoperative convalescence and lower cost of hospitalization. CONCLUSION: According to these results we believe that immediate laparoscopic cholecystectomy (within 24 hours from the patient's admission to hospital) should become a preferred method of treatment of the patients with acute cholecystitis (Tab. 1, Fig. 2

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

“…Surgery timing was indicated as early cholecystectomy or delayed cholecystectomy. Early was defined as within 72 h since onset (as recommended in TG13) in two papers ; within 24 h of hospital admission in two papers ; within 24 h since the study began in one paper ; within 72 h since patient presentation (or admission) or the study start in six papers ; within 4 days in one study ; within 1 week since onset in one study ; and as soon as possible after patient presentation (with the actual timing not recorded) in two studies . Delayed was defined in various different ways, including after diagnosis or after the symptoms diminished, but was most commonly defined as after at least 6 weeks.…”

“…The TG13 guidelines basically recommended early surgery as the treatment for AC, with a specific recommendation for cholecystectomy soon after hospitalization if no more than 72 h has passed since symptom onset. Two randomized controlled trials compared delayed cholecystectomy versus early cholecystectomy in patients where symptoms started no more than 72 h previously . In both of these trials, the early surgery group had shorter total hospital stays and shorter operating times.…”

Relationship between clinical and histopathological features of patients undergoing cholecystectomy

“…The LC done in acute cholecystitis after 72 h has a long operating time, increased blood loss, high OC conversion rate, and long-term hospitalisation [16]. Previous studies have suggested early OC because of its safety, low cost, and the advantages of an early return to normal activities [17][18][19]. Subsequent randomised clinical trials suggest an early LC procedure because of an early recovery, short hospital stay, and overall cost advantages.…”

“…Cholecystectomy is usually performed several days after percutaneous transhepatic biliary drainage. Early cholecystectomy is recommended if the patient's condition has improved after drainage and complications have not developed in the patient [17,18]. Cholecystectomy should be considered after percutaneous gallbladder drainage and medical treatment in patients with high-risk acute cholecystitis [19][20][21].…”

Сomplications of Gallstone Disease

“…Второй этап (холецистэктомию) планируют в плановом порядке через несколько недель после тщательной предоперационной подготовки. При большом риске выполнения радикальной операции предлагается проведение склерозирования желчного пузыря путём лазерной коагуляции слизистой после литотрипсии и литоэкстракции через холецистостому [2,11,12,13,14,15,16,17,18]. Cледует отметить, что при первичном вмешательстве или на фоне холецистостомы может встретиться воспалительный инфильтрат в области шейки желчного пузыря, который значительно затрудняет дифференцировку тканей.…”