Immediate versus delayed laparoscopic cholecystectomy in patients with acute cholecystitis : a retrospective audit

Abstract EN

Background : Laparoscopic cholecystectomy has become the gold standard for the surgical treatment of acute cholecystitis. However, controversies still arise regarding the timing of the laparoscopic approach for optimum results.

The aim of this study is to compare outcomes of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy. Method : During a 12-month period (01 / 03 / 11–10 / 04 / 12) all laparoscopic cholecystectomies performed were reviewed. Pre-operative, operative, and post-operative clinical notes and files were collected.

A total of 43 patients were included in this audit as they met the selection criteria, with 24 patients in the early group versus 19 in the delayed.

Of these, 29 were female and 14 male with a mean age of 41.8 years and 42.4 years respectively. Results : Cholecystectomy was successfully completed in 42 patients (97.67 %), conversion to open was necessary in one patient in the early group.

There was no morbidity, mortality, or injury to the common bile duct during this period.

No significant difference was seen in terms of post-operative complications.

Mean immediate post-surgery hospital stay was 1.04 days for the early group, compared with 1.53 days in the delayed. Conclusion : Early laparoscopic cholecystectomy for acute cholecystitis, within 48-72 hours of presenting symptoms, has proven to be the preferred approach by both surgeons and patients.

It allows for a shorter hospital stay, satisfactory complication levels and reduced costs.

A policy should be implemented to evaluate each patient individually, and consider associated co-morbidities and surgeons’ experience.