title: Delayed Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: Is it Time for a Change?
abstract: Our aim was to evaluate the advantages and limitations of delayed laparoscopic cholecystectomy (LC) in a tertiary center.
  
  
  
  A retrospective analysis of all patients admitted to our institution with acute calculous cholecystitis (ACC) between January 2003 and December of 2012 was performed. Data collected included patient demographics and comorbidities, presenting symptoms, laboratory findings, imaging results, length of stay (LOS), time to surgery, and surgical complications.
  
  
  
  A total of 1078 patients were admitted with ACC. There were 593 females (55%), and the mean age was 57 ± 0.6 years. Mean LOS at initial admission, re-admission until surgery, and following surgery was 7.9 ± 0.2, 1.5 ± 0.1, and 3.4 ± 0.2 days, respectively. Percutaneous cholecystostomy (PC) tube was inserted in 24% of the patients. Only 640 (59%) patients eventually underwent LC. Mean time to surgery was 97 ± 9.8 days, and 16.4% of patients were readmitted in this time period resulting in a mean total LOS of 10.6 ± 0.2 days. Conversion rate to open surgery was 5.8% and bile duct injury occurred in 1.1%. Postoperative complications occurred in 9.8% of the patients, and 30-day mortality was 0.6%. Patients with more severe inflammation according to Tokyo Criteria grade were more likely to undergo PC, were more likely to be readmitted while waiting for LC, and also had more postoperative complications.
  
  
  
  Delayed LC is associated with significant loss of follow-up, long LOS, and higher than expected use of PC. Conversion rates are lower than in the literature while rates of bile duct injury and mortality are comparable. We believe these data as well as the available literature are sufficient to change our hospital policy regarding the surgical treatment of ACC from delayed to early same admission surgery in appropriate cases.
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel. jyuval@gmail.com.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Yuval
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Mizrahi
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weiss
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Gidon
authors.initials: G
authors.lastname: Almogy
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Miklosh
authors.initials: M
authors.lastname: Bala
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Kuchuk
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Baha
authors.initials: B
authors.lastname: Siam
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Natalia
authors.initials: N
authors.lastname: Simanovsky
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eid
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel.
authors.forename: Alon J
authors.initials: AJ
authors.lastname: Pikarsky
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors