title: Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis.
abstract: 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.
authors.affiliation: Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee, UK. s.hadad@hotmail.co.uk
authors.forename: Sirwan M
authors.initials: SM
authors.lastname: Hadad
authors.forename: Jayant S
authors.initials: JS
authors.lastname: Vaidya
authors.forename: Lee
authors.initials: L
authors.lastname: Baker
authors.forename: Hoey C
authors.initials: HC
authors.lastname: Koh
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Heron
authors.forename: Kashif
authors.initials: K
authors.lastname: Hussain
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Thompson
mesh_terms: 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