The timing of laparoscopic cholecystectomy in acute cholecystitis: importance of first 72 hours and oxidative stress markers

Abstract

BACKGROUND: This prospective randomized study aims to compare outcomes between immediate laparoscopic cholecystectomy (LC) and same admission delayed LC in patients with acute cholecystitis and also to investigate the relation between oxidative stress markers and complication rates in the patients with AC. METHODS: This study included 64 patients with AC who were randomly divided into two groups. Patients in Group 1 (n=32) were immediately administered LC, while in Group 2 (n=32) patients underwent transient LC following medical treatment. All patients were operated on their first hospitalization. RESULTS: No statistically significant differences were observed between the groups for the comparison of complications, conversion rates, or operation durations (p>0.05). The length of postoperative hospital stay was found to be significantly shorter in group 1 compared to group 2 (1.75 vs 2.93 days; p=0.024). Only the total antioxidant status result was significantly higher in group 1 (p=0.017), but the finding was not correlated with complications. CONCLUSION: LC for AC was performed during the first admission was found to be safe, even beyond 72 hours following symptom onset. Pre-operative oxidative stress markers did not correlate with the complication rates.

The role of ischemia-modified albumin, presepsin, delta neutrophil index, and inflammatory markers in diagnosing acute cholecystitis

“…In the study conducted by Arslan Onuk et al, values of oxidative stress markers, including TAS, TOS, and OSI, were found to be elevated in patients with acute cholecystitis compared to those in the control group. [20] Similarly, in our study, oxidative stress markers (TAS, TOS, OSI) were found to be higher in patients with acute cholecystitis than in the control group. The data examining the relationship between TAS/TOS/OSI and acute cholecystitis presented in this study is rare in the literature, providing detailed insights into this relationship.…”

Timing of Early Cholecystectomy for Acute Calculous Cholecystitis: A Multicentric Prospective Observational Study

“…In these studies, no differences in post-operative complication rate and conversion rate were found, but patients who received EC within 72 h had a significantly shorter post-operative LOS. In the studies by Chandler et al [12] and by Onuk et al [13] there was no difference in the duration of the surgery, while in the study by Jan et al [14] the operative time was longer in patients who were operated on after 72 h. Furthermore, Jan et al [14] did not find a significant difference in intraoperative complications, while Chandler et al [12] found significantly greater blood loss in those operated on after 72 h. However, none of the randomized controlled trials and the prospective non-randomized studies had enough powered sample size. The only study that reported data about sample size calculation [13], had a power of 34%.…”

“…In the studies by Chandler et al [12] and by Onuk et al [13] there was no difference in the duration of the surgery, while in the study by Jan et al [14] the operative time was longer in patients who were operated on after 72 h. Furthermore, Jan et al [14] did not find a significant difference in intraoperative complications, while Chandler et al [12] found significantly greater blood loss in those operated on after 72 h. However, none of the randomized controlled trials and the prospective non-randomized studies had enough powered sample size. The only study that reported data about sample size calculation [13], had a power of 34%. A Cochrane systematic review [15] highlighted the difficulty of obtaining sufficient data on this topic through randomized controlled trials because studies with enough power would involve thousands of patients.…”

“…No differences in complication rate and bile duct injuries have been found [4]. The literature features three randomized controlled trials [12][13][14] and other prospective non-randomized studies [6,11] that compare different timings of EC from the onset of symptoms. Three randomized controlled trials randomized patients with ACC to receive EC within 72 h or after 4-7 days from the onset of symptoms.…”