Comparison of laparoscopic cholecystectomy for acute cholecystitis within and beyond 72 h of symptom onset during emergency admissions.
BACKGROUND
Laparoscopic cholecystectomy (LC) performed for acute cholecystitis (AC) is usually advised within 72 h of symptom onset. It can be difficult to accommodate all these patients within 72 h. LC beyond this early phase potentially increases the chances of LC-related complications. The aim of this study was to evaluate the outcomes of LC both within and beyond 72 h of presentation during the emergency admission.


METHODS
A retrospective clinical study was performed from February 2004 to December 2009. A total of 133 patients underwent LC for AC during the emergency admission according to the protocol: 34 patients underwent early LC (ELC) (i.e., operation within 72 h of symptom onset) and 99 underwent late LC (LLC) (i.e., operation beyond 72 h of symptom onset). Pathologic type of cholecystitis, duration of the procedure, conversion rate, complications, length of hospital stay (LOS), and total charges were compared between the two groups.


RESULTS
Patients undergoing ELC experienced a significantly shorter operating time (44.1 ± 5.32 vs. 66.4 ± 3.05 min, p < 0.01). Most of the AC (95/133, 71 %) was pathologically simple cholecystitis. There was no significant difference regarding wound infection rates [1/34 (2.94 %) vs. 2/99 (2.02 %), p > 0.05] or postoperative hospital stay (6.50 ± 1.31 vs. 6.67 ± 0.73, p > 0.05) between groups. There were no conversions to open cholecystectomy, no biliary tract injury or biliary leak, no other complications, and no 30-day readmission rates in either group. ELC was less costly than LLC (6,692 ± 794 vs. 8,378 ± 802 RMB, p < 0.05).


CONCLUSIONS
Both ELC and LLC are safe for treating of AC, but the operative difficulty of LLC is greater. ELC is superior to LLC as it tends to shorten the total LOS and is less expensive.
Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, China. binbinzhu99@hotmail.com
Bin
B
Zhu
Zhanzhi
Z
Zhang
Yan
Y
Wang
Ke
K
Gong
Yiping
Y
Lu
Nengwei
N
Zhang
D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D013997:Time Factors