How early is early laparoscopic treatment of acute cholecystitis?

Prospective randomized trial using cost–utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease

“…If early laparoscopic cholecystectomy were to become routine practice, increased emergency operating capacity would be required, not only because of pressures on emergency lists but also because the longer symptom duration might result in more technical difficulties. It has been thought that 72 h of symptoms represents the threshold before difficult dissection and an increased need to convert to open surgery occurs 16 ; others have considered 96 h to be the ceiling 17 . In a retrospective study of 608 patients, conversion rates increased according to duration of symptoms: 0-2 days, 9·5 per cent; 3-4 days, 16·1 per cent; 5-6 days, 38·9 per cent; and more than 6 days, 38·6 per cent 18 .…”

Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

“…4,21 For patients with severe acute cholecystitis, delayed surgery after initial conservative therapy or open cholecystectomy has been selected because of difficulties associated with early laparoscopic treatment. However, technical advances and increased experience have gradually led surgeons to attempt laparoscopic surgery in cases of acute gangrenous cholecystitis.…”

Ultrasound for the Diagnosis of Acute Calculous Cholecystitis, and the Impact of Analgesics: A Retrospective Cohort Study

“…Such complications include; bacterial infection of the gallbladder, perforation, and emphysematous cholecystitis which involves gas in the gallbladder wall produced by certain infectious bacteria (NJ and G 2012). The standard treatment for cholecystitis is laparoscopic cholecystectomy, however if diagnosis is delayed resulting in a delayed cholecystectomy, complications may necessitate open surgery (Eldar et al 1997, Peng et al 2005, Madan et al 2002 The diagnostic tool of choice is ultrasound. It is more sensitive and specific than CT or MRI, and while some studies report greater diagnostic accuracy with cholescintigraphy (Shea 1994), ultrasound is still preferred due to clinician preference and cost (Pinto et al 2013).…”

“…Noble et al (2010) compared the use of 5mg IV meperidine (pethidine) vs. placebo on the presence of SMS in a pilot study. 5mg IV of meperidine is a small dosage (equivalent to 0.5mg IV morphine) (Latta et al 2002), and unlikely to produce much pain relief or affect SMS. This study used an ED diagnosis if pathological diagnosis was unavailable.…”