Evaluation of early versus delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis

Abstract

Background/aims: The optimal timing of laparoscopic cholecystectomy (LC) in the treatment of acute cholecystitis remains controversial. This retrospective study was undertaken to assess the clinical outcomes, possible advantages and disadvantages of early versus delayed LC for acute cholecystitis.

Materials and methods: Records of all patients admitted for acute cholecystitis in whom laparoscopic cholecystectomy was attempted between January 2004 and January 2006, at National Taiwan University Hospital were reviewed.

Results: A total of 89 patients were recruited to the study. Of these, 56 patients received early laparoscopic cholecystectomy (ELC), and 33 patients received delayed laparoscopic cholecystectomy (DLC) following conservative therapy. There were no intergroup differences in age, gender, or days of symptoms prior to presentation. Patients undergoing ELC experienced a significantly longer operation time (109 +/- 37.59 minutes versus 77 +/- 25.65 minutes, p < 0.001), more blood loss (76ml versus 28ml, p = 0.006) and a longer post-operation hospital stay (4.5 days versus 2.6 days, p < 0.001). The conversion rate to open cholecystectomy was not significantly different (4/56 versus 2/33, p = 0.84), and there were no biliary tract injury or other major complications in either group. However, patients with ELC had a shorter total hospital stay (4.53 days versus 7.79 days, p < 0.001) and fewer admission times (1 time in ELC versus 2.4 times in DLC, p < 0.001).

Conclusions: Both early and delayed LC appears to be effective and safe in the treatment of acute cholecystitis. Early LC may be more technically demanding and time-consuming, and may be associated with a higher rate of wound infections; however, it also tends to shorten the total length of hospital stay and reduce the risk of repeat cholecystitis. We recommend early LC for acute cholecystitis comparison with delayed LC.