Timing of Laparoscopic Cholecystectomy for Acute Cholecystitis: Evidence to Support a Proposal for an Early Interval Surgery

Abstract

We evaluated the safety and feasibility of delayed urgent laparoscopic cholecystectomy (LC) performed beyond 72 hours to overcome the logistical difficulties in performing early urgent LC within 72 hours of admission with acute cholecystitis (AC), and to avoid earlier readmission with recurrent AC in patients awaiting delayed interval. Patients admitted with AC were scheduled for urgent LC. Patients who underwent early urgent LC were compared with those who had delayed urgent surgery. Fifty consecutive patients underwent urgent LC for AC within 2 weeks of admission. There were no conversions and no bile duct injuries. Delayed surgery (n = 36) neither prolonged operating time (90 vs 85 minutes), nor increased operative morbidity (9.7% vs 7.7%) or mortality (2.4% vs 7.7%) compared with early surgery (n = 14). Although delayed surgery was associated with shorter postoperative hospital stay (1 vs 2 days, P = 0.029), it prolonged total hospital stay (9 vs 5 days, P < 0.0001). Delay of LC beyond 72 hours neither increases operative difficulty nor prolongs recovery. It might be more cost effective to schedule patients who could not undergo early urgent LC but are responding to conservative treatment for an early interval LC within 2 weeks of presentation with AC.

Effi cacy of Acute Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis Regardless the Length of Symptoms

“…[1] Although it is obvious that optimal indication for acute laparoscopic cholecystectomy in acute cholecystitis is as early after the onset of symptoms as possible, there is some data available that the time factor may not be a prohibitive parameter for surgery in case that sufficient expertise is available. [3,4] Presented treatment outcomes in our serie of one hundred and thirty consecutive patients with acute calculous cholecystitis treated by laparoscopic cholecystectomy regardless the length of symptoms in the tertiary referral center are favourably comparable to the results accross the literature. [7,9] Acute laparoscopic cholecystectomy thus appears to by highly effective in experienced hands despite prolonged symptoms and particularly complex referral patient population.…”

“…[1] Nevertheless, some limited data suggest that laparoscopic surgical management may also provide favorable results following the interval of 72 hours in experienced centers. [3][4][5] The aim of the study was to assess the efficacy of acute laparoscopic cholecystectomy for acute calculous cholecystitis in the tertiary referral center with the policy to opt for laparoscopic procedure regardless the time interval from onset of the symptoms.…”

Evaluation of early cholecystectomy for acute cholecystitis within 10 days of onset, with arguments based on histopathological findings

“…Some reports describe similar findings to ours. Low et al recommended urgent LC from 72 h to 2 weeks after admission, while Popkharitov et al reported that LC performed 4-7 days after symptom onset is not inferior to earlier LC in terms of surgical outcomes [15,16].…”

Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)

“…From these results, the level of surgical difficulty might be predictable on the basis of factors including preoperative imaging and blood tests, and TG13 grade. Some studies investigating surgical timing and surgical difficulty also found that if surgery was performed within 72 h of the onset of AC, there were fewer complications, operating time was shorter, and surgical difficulty was lower . One issue is that almost all these studies were observational studies derived from single‐center data, and no studies have provided a high level of evidence.…”