[What is the best timing to perform laparoscopic cholecystectomy in acute cholecystitis?].
Early laparascopic cholecystectomy within five days of onset of symptoms of acute cholecystitis has proved superior to open cholecystectomy. Feasability is well established; the conversion rate to open cholecystectomy and the post-operative morbidity are no higher than with delayed laparascopy after initial medical management. Total hospitalization is, on the other hand, significantly shorter. Only one study showed an increase in operative time with early surgery (on average 15 minutes). Both preoperative and perioperative risk factors for conversion to laparotomy were identified. Prompt laparascopic intervention avoids the complications which may arise with initial medical management, i.e., failure of medical management or biliary peritonitis. Early laparascopic cholecystectomy should be considered the  gold standard  for management of acute cholecystitis.
Laporte
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S
Département de chirurgie et de cancérologie digestive, Hôpital Caremeau--Nîmes. sylvian.laporte@chu-nimes.fr
Navarro
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F
D000208:Acute Disease; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D006801:Humans; D013997:Time Factors