Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.
OBJECTIVE
The current study compared the results of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.


BACKGROUND
Although recent reports have suggested the use of laparoscopic cholecystectomy for acute cholecystitis, the complication and conversion rates remain high. No data are available on whether initial medical treatment can improve the results.


METHODS
Among 497 patients who underwent laparoscopic cholecystectomy, 52 (10.5%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. Twenty-seven of these patients had early surgery, that is, within 120 hours of admission, and 25 had interval cholecystectomy after initial medical treatment.


RESULTS
The early group required modifications in operative technique more frequently (p < 0.001). The conversion rate (7.4%) and minor complication rate (22%) were comparable. Successful early laparoscopic cholecystectomy required a longer operative time (137.2 minutes vs. 98.0 minutes; p < 0.05) and postoperative hospital stay (4.6 days vs. 2.5 days; p < 0.005) but reduced the total hospital stay (6.4 days vs. 12.4 days; p < 0.001).


CONCLUSIONS
Early laparoscopic cholecystectomy for the treatment of acute cholecystitis has no adverse effect on complication and conversion rates. Although it is technically demanding and time consuming, this procedure provides the economic advantage of a markedly reduced total hospital stay.
Lo
C M
CM
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Liu
C L
CL
Lai
E C
EC
Fan
S T
ST
Wong
J
J
D000208:Acute Disease; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography