title: Cholecystectomy for acute cholecystitis. How time-critical are the so called "golden 72 hours"? Or better "golden 24 hours" and "silver 25-72 hour"? A case control study.
abstract: BACKGROUND
  Early cholecystectomy within 72 hours has been shown to be superior to late or delayed cholecystectomy with regard to outcome and cost of treatment. Recently, immediate cholecystectomy within 24 hours of onset of symptom was proposed as standard procedure for the management of fit patients presenting with acute cholecystitis. We sort to find out if there are any differences in surgical outcomes between patients managed within 24 h and those managed 25-72 h following symptom begin for acute cholecystitis.
  
  
  METHODS
  A retrospective analysis was performed. The outcomes of patients undergoing laparoscopic cholecystectomy within 24 h were compared to those of patients managed 25-72 h following symptom onset for acute cholecystitis.
  
  
  RESULTS
  35 patients managed 25-72 h following begin of symptoms were matched with 35 patients with similar baseline features, medical comorbidities and disease severity managed within 24 hours of symptom onset. There were no significant differences in the duration of surgery, postoperative complications, rate of conversion and length of hospital stay.
  
  
  CONCLUSIONS
  Immediate laparoscopic cholecystectomy for acute cholecystitis within 24 hour of symptom onset is not superior to surgery 25-72 hour after symptoms begin. Laparoscopic cholecystectomy for acute cholecystitis therefore can be safely performed anytime within the golden 72 h.
authors.affiliation: Helios Klinikum Wuppertal, Department of Surgery II, Witten/Herdecke University, Heusner Strasse 40, 42283 Wuppertal, Germany ; Department of General, visceral and thoracic surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379 Leverkusen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ambe
authors.affiliation: Department of Internal Medicine, St. Elisabeth Hospital Hohenlind, 50377 Köln, Germany.
authors.forename: Sebastian A
authors.initials: SA
authors.lastname: Weber
authors.affiliation: Department of medical statistics and epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Hildegard
authors.initials: H
authors.lastname: Christ
authors.affiliation: Department of General, visceral and thoracic surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379 Leverkusen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Wassenberg
keywords: Acute cholecystitis; Early cholecystectomy; Gallbladder inflammation; Immediate cholecystectomy; Laparoscopic cholecystectomy; Timing of cholecystectomy; Tokyo guidelines