Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 1;111(10):6905-6913.
doi: 10.1097/JS9.0000000000002867. Epub 2025 Jul 15.

Proactive emergency laparoscopic cholecystectomy for complex acute cholecystitis: a prospective cohort at a national emergency center in China

Qiaofei Liu  1   2 , Xianlin Han  1   2 , Guannan Zhang  1   2 , Hua Huang  1   2 , Shaobo Chen  1   2 , Hongyu Wang  1   2 , Xin Ye  1   2 , Xin Wu  1   2 , Junyang Lu  1   2 , Beizhan Niu  1   2 , Lai Xu  1   2 , Qu Xiang  1   2 , Wenjing Liu  1   2 , Chen Lin  1   2 , Feng Tian  1   2 , Jianchun Xiao  1   2 , Surong Hua  1   2 , Weijie Chen  1   2 , Yinxin Wei  1   2 , Rui Hou  1   2 , Mengqing Sun  1   2 , Xiafei Hong  1   2 , Mengyi Wang  1   2 , Zhe Cao  1   2 , Qianqian Shao  1   2 , Ning Zhang  1   2 , Xianze Wang  1   2 , Bangbo Zhao  1   2 , Junyi Gao  1   2 , Gang Yang  1   2 , Lin Cong  1   2 , Wei Liu  1   2 , Binglu Li  1   2 , Jorg Kleeff  1   2 , Taiping Zhang  1   2 , Weibin Wang  1   2 , Yupei Zhao  1   2
Affiliations

Proactive emergency laparoscopic cholecystectomy for complex acute cholecystitis: a prospective cohort at a national emergency center in China

Qiaofei Liu et al. Int J Surg. .

Abstract

Background: While emergency laparoscopic cholecystectomy (ELC) is the standard treatment for acute cholecystitis (AC), optimal management of complex cases, particularly those with symptom duration ≥7 days or severe inflammation, remains controversial.

Objective: To assess the feasibility and safety of a proactive protocol for ELC in patients with complex AC, including high-risk cases defined by advanced age, prolonged symptoms, or severe inflammation (Tokyo Guidelines grade II/III).

Methods: From 1 August 2020 to 1 February 2024, the emergent surgical teams at Peking Union Medical College Hospital (National Emergent Surgery Center in North China) prospectively implemented proactive ELC for AC patients, irrespective of symptom duration and inflammatory severity. Intraoperative indocyanine green cholangiography (ICG-C) was selectively employed based on the surgeon's discretion. Clinicopathological data and perioperative outcomes were analyzed to assess safety and efficacy. Logistic regression and multi-way ANOVA were employed to assess the effects of multiple independent variables.

Results: Among 721 enrolled patients, 576 (79.9%) were interprovincial referrals, and 342 (47.7%) were transferred from external hospitals. More than half of the patients suffered from at least one comorbidity. The median age was 60 ± 16.7 years, with 11.5% aged >80 years. Symptom duration exceeded 3 days in 343 (47.6%) and 7 days in 190 (26.4%) of cases. Most patients had advanced disease (334 (46.3%) grade II, 199 (27.6%) grade III). Mean operative time was 64 ± 36.5 minutes, with intraoperative blood loss (IBL) of 65.0 ± 177.4 ml. Seven cases (1%) required conversion to open surgery, 39 (5.4%) underwent partial cholecystectomy, and 3 (0.4%) experienced iatrogenic colon injuries. Reoperation occurred in 2 cases (0.3%). The overall postoperative complication rate was 6.9%, with severe complications (Clavien-Dindo grade ≥III) at 1.2%. Patients older than 80 years did not have a higher rate of complications (P = 0.14). Patients with symptom duration ≥ 7 days had similar rates of partial resection and overall complications to those with 4-6 days. Although grade II/III had substantial adverse intraoperative and postoperative effects (all items, P ≤ 0.001), the overall rate of complications remains low (8.4%). ICGC correlated with reduced partial resection rates (0.7% vs. 6.3%, P = 0.005) and lower intraoperative blood loss (44.7 ± 82.8 mL vs. 69.4 ± 194.0 mL, P < 0.001).

Conclusions: Proactive ELC could be safe and effective for complex AC, even in elderly patients (≥80 years), prolonged symptom duration (≥7 days), and severe disease (grade II/III), when performed in high-volume centers. ICGC enhances precision, mitigating incomplete resections and bleeding.

Keywords: acute cholecystitis; emergent laparoscopic cholecystectomy; indocyanine green cholangiography; prospective cohort china.

PubMed Disclaimer

References

    1. Gallaher JR. Charles a: acute cholecystitis: a review. JAMA 2022;327:965–75.
    1. Wong GYM, Wadhawan H, Roth Cardoso V, et al. 30-day morbidity and mortality after cholecystectomy for benign gallbladder disease (AMBROSE): a prospective, international collaborative cohort study. Ann Surg 2024;281:312–21.
    1. Pisano M, Ceresoli M, Cimbanassi S, et al. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg 2019;14:10.
    1. Shabanzadeh DM, Christensen DW, Ewertsen C, et al. National clinical practice guidelines for the treatment of symptomatic gallstone disease: 2021 recommendations from the Danish Surgical Society. Scand J Surg 2022;111:11–30.
    1. Takahashi N, Umemura A, Suto T, et al. Aggressive laparoscopic cholecystectomy in accordance with the Tokyo guideline 2018. Jsls 2021;25:e2020–00116.