Timing of laparoscopic cholecystectomy for subacute calculous cholecystitis: early or interval--a prospective study.
OBJECTIVE
The aim of this prospective study was to evaluate the safety and feasibility of early laparoscopic cholecystectomy for subacute cholecystitis and to compare it with interval laparoscopic cholecystectomy.


METHODS
The study was performed in 74 patients who had been diagnosed with subacute cholecystitis between January 2000 and June 2005. The patients were divided into two groups. The early laparoscopic cholecystectomy group was composed of 31 patients who underwent laparoscopic cholecystectomy 24 h after admission to the hospital. The interval laparoscopic cholecystectomy group was composed of 43 patients who underwent laparoscopic cholecystectomy 8-12 weeks after medical treatment.


RESULTS
There was no significant difference between the conversion rate, intraoperative bleeding, need for intraoperative cholangiography, minor bile duct injury, and postoperative complications in the two groups. Eleven patients in the interval group underwent urgent laparoscopic cholecystectomy or additional procedures because of recurrent cholecystitis, choledocholithiasis, or biliary pancreatitis. The early group had a significantly shorter total hospital stay (P = 0.031), lower cost of treatment (P = 0.042), and less difficulty with Calot's triangle dissection (P = 0.008).


CONCLUSIONS
Early laparoscopic cholecystectomy can be done without hesitation in patients with subacute cholecystitis, in the light of obstacles observed in the interval group, such as dissection difficulty, lack of success in "cooling down", and additional problems such as choledocholithiasis and biliary pancreatitis.
Yüksel
Osman
O
Gazi University Medical School, Department of General Surgery, Hepato-Pancreato-Biliary Surgery Unit, Beşevler, 06500, Ankara, Turkey.
Salman
Bülent
B
Yilmaz
Utku
U
Akyürek
Nusret
N
Tatlicioğlu
Ertan
E
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries; D016063:Blood Loss, Surgical; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002764:Cholecystitis / Q000209:etiology / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013995:Time; D013997:Time Factors