Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis.
BACKGROUND
Randomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate.


METHODS
We performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis.


RESULTS
Of patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0-2 days, 3-4 days, 5-6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions.


CONCLUSIONS
Early intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.
Hadad
Sirwan M
SM
Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee, UK. s.hadad@hotmail.co.uk
Vaidya
Jayant S
JS
Baker
Lee
L
Koh
Hoey C
HC
Heron
Timothy P
TP
Hussain
Kashif
K
Thompson
Alastair M
AM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000175:diagnosis / Q000601:surgery*; D018450:Disease Progression; D004630:Emergencies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom