title: Should acute cholecystitis be operated in the 24 h following symptom onset? A retrospective cohort study.
abstract: BACKGROUND
  Early laparoscopic cholecystectomy is the gold standard for management of acute cholecystitis (AC). Nevertheless, the definition used for early phase remained unclear. We aimed to compare the clinical outcome and cost of immediate (patients undergoing laparoscopic cholecystectomy within 24 h following symptom onset) versus early laparoscopic cholecystectomy (patients managed 25-72 h following symptom onset) for acute cholecystitis.
  
  
  METHODS
  A retrospective analysis was performed. The outcomes of 143 patients undergoing laparoscopic cholecystectomy within 24 h (ICG) were compared to 350 patients managed 25-72 h following symptom onset (ECG) for acute cholecystitis.
  
  
  RESULTS
  There were significantly more diabetic patients in the early laparoscopic group (ECG). All other characteristics were comparable (demographic, clinical, biologic and ultrasonographic characteristics) between the two groups. The rate of conversion to open surgery was significantly higher in the ECG. Overall postoperative morbidity and specific morbidity did not differ significantly between the groups. Total hospital stay was longer in the ECG. Direct medical costs were higher in the ECG.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy, for acute cholecystitis, during the first 24 h of onset of symptoms, significantly reduced conversion to open surgery and total hospital stay without increasing postoperative complications.
authors.affiliation: Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia. Electronic address: bouassidamahdi@yahoo.fr.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Bouassida
authors.affiliation: Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Lamine
authors.initials: L
authors.lastname: Hamzaoui
authors.affiliation: Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Bassem
authors.initials: B
authors.lastname: Mroua
authors.affiliation: Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Mohamed Fadhel
authors.initials: MF
authors.lastname: Chtourou
authors.affiliation: Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Slim
authors.initials: S
authors.lastname: Zribi
authors.affiliation: Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Mohamed Mongi
authors.initials: MM
authors.lastname: Mighri
authors.affiliation: Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Hassen
authors.initials: H
authors.lastname: Touinsi
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics; D041881:Cholecystitis, Acute / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Acute cholecystitis; Conversion; Early cholecystectomy; Immediate cholecystectomy; Laparoscopy; Morbidity