Acute cholecystitis, Cholecystectomy, Early cholecystectomy, Laparoscopic
Citation Information :
Lal S, Rohitaj R, Najim M, Dua M, Chakravarti S. Early and Delayed Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis: A Prospective Randomized-comparative Study. World J Lap Surg 2021; 14 (3):149-156.
Background: Acute cholecystitis is a very common gastrosurgical emergency. The timing of laparoscopic cholecystectomy (LC) in cases of acute cholecystitis is still a matter of debate. In general, delayed LC is preferred because of higher morbidity and conversion rate when LC is performed in acute cholecystitis.
Aim and objective: To compare the various parameters and outcomes between early and delayed laparoscopic cholecystectomies with safety and feasibility evaluation.
Materials and methods: A prospective, randomized controlled, interventional study was conducted from October 2017 to February 2019. Patients with a diagnosis of acute cholecystitis post-randomization were assigned into the early group (n = 50; LC within 72 hours of admission) and the delayed group (n = 50; initial conservative treatment followed by delayed LC 6–12 weeks later). The primary outcome measures were intraoperative and postoperative complications (bile duct injuries, bile leak, and wound infection), morbidity, mortality conversion, and length of hospital stay. The secondary outcome measures were the mean duration of surgery, the mean blood loss, other complications (subhepatic collection, postoperative pneumonia), and unsuccessful nonoperative management.
Results: In our study, the conversion rate in early laparoscopic cholecystectomy (ELC) group was 5 (10%) and delayed laparoscopic cholecystectomy (DLC) group was 7 (14%), respectively. The mean operative time was 77.30 ± 20.078 vs 66.94 ± 29.501 minutes; p <0.001 in ELC and DLC groups, respectively; the mean blood loss was 82.60 ± 59.67 vs 65.40 ± 74.21; p <0.007 in ELC and DLC groups, respectively. Postoperative complication was 4 (8%) vs 7 (14%) for ELC and DLC groups, respectively. However, the patients in the ELC group had a significantly shorter hospital stay (4.46 ± 1.32 vs 6.0 ± 2.54 days; p <0.002).
Conclusion: Early cholecystectomy is safe and feasible in patients with acute cholecystitis. Early cholecystectomy offers definitive treatment as it eliminates risks of failed conservative management and repeated episodes of acute cholecystitis with the advantage of shorten mean hospital stay without increased morbidity and mortality.
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