title: What is the optimal time for laparoscopic cholecystectomy in gallbladder empyema?
abstract: OBJECTIVE
  With the accumulating experience in laparoscopic surgery, early laparoscopic cholecystectomy (LC) is increasingly offered for acute cholecystitis. However, early LC without percutaneous transhepatic gallbladder drainage (PTGBD) for gallbladder empyema is still believed to be unsafe. The purpose of this study was to determine the optimal time for LC in gallbladder empyema.
  
  
  METHODS
  A retrospective analysis was carried out of patients who underwent LC without PTGBD for gallbladder empyema between August 2007 and December 2010. All cases were confirmed by biopsy. The patients were divided into two groups on the basis of a cutoff of 72 h.
  
  
  RESULTS
  LC for gallbladder empyema was performed without PTGBD in 61 patients during the study period. The overall conversion rate was 6.6 %. Based on the 72 h cutoff, there were 33 patients in the early group and 28 in the delayed group. There were no significant differences between early and late patients with respect to operation duration (75.5 vs. 71.4 min, p = 0.537), postoperative hospital stay (4.2 vs. 3.3 days, p = 0.109), conversion rate (12.1 vs. 0 %, p = 0.118), and complication rate (12.1 vs. 3.6 %, p = 0.363). However, the early group had a significantly shorter total hospital stay (5.3 vs. 8.7 days, p = 0.001).
  
  
  CONCLUSIONS
  Early LC without PTGBD is safe and feasible for gallbladder empyema and is associated with a low conversion rate. Delayed LC for gallbladder empyema has no advantages and results in longer total hospital stays. LC should be performed as soon as possible within 72 h after admission to decrease length of hospital stay.
authors: Department of Surgery, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, Korea, skull21c@kornet.net.
authors: Yong Jin
authors: YJ
authors: Kwon
authors: Byung Kyu
authors: BK
authors: Ahn
authors: Hwon Kyum
authors: HK
authors: Park
authors: Kwang Soo
authors: KS
authors: Lee
authors: Kyeong Geun
authors: KG
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000473:pathology / Q000601:surgery*; D004322:Drainage / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013492:Suppuration; D013997:Time Factors; D019564:Unnecessary Procedures
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