Safe laparoscopic cholecystectomy technique and timing for acute cholecystitis: a study in India

Venkata Sai Sreenivas Uchintala; Uma Sankar Srinivasan; Tajuddin Syed; Eswar Gollahalli Prabhu; Shaktivel Selvam

doi:10.18203/2349-2902.isj20233923

Authors

Venkata Sai Sreenivas Uchintala Department of General Surgery, KMC, Guntur, Andhra Pradesh, India
Uma Sankar Srinivasan Department of General Surgery, KMC, Guntur, Andhra Pradesh, India
Tajuddin Syed Department of General Surgery, KMC, Guntur, Andhra Pradesh, India
Eswar Gollahalli Prabhu Department of General Surgery, KMC, Guntur, Andhra Pradesh, India
Shaktivel Selvam Department of General Surgery, KMC, Guntur, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20233923

Keywords:

Acute cholecystitis, LC, Operation timing, Technique

Abstract

Background: Acute cholecystitis patients undergo laparoscopic cholecystectomy (LC) within 72 hours or 6 weeks to 12 weeks after onset is widely considered the optimal timings for LC. However, there has been no clear consensus about it. We aimed to determine safe technique of LC for acute cholecystitis within 72 hours or any time of presentation with no delay in surgery.

Methods: Medical records of 100 patients who underwent standard LC were reviewed retrospectively. Patients were divided into group 1, patients undergoing LC within 72 hours of onset; group 2, between 4 days to 14 days; group3, between 3 weeks to 6 weeks; group 4, more than 6 weeks.

Results: No significant differences existed between groups in conversion rate to open surgery, operation time, blood loss, or postoperative morbidity, and hospital stay. However, total hospital stays in groups 1 and 2 was significantly shorter than that in groups 3 and 4 (p<0.01). In addition, the total hospital stay in group 3 was also significantly shorter than that in group 4 (p<0.01).

Conclusions: Best timing of LC for acute cholecystitis may be within 72 hours, and there is no need to delay LC in patients presenting after 72 hours and with safe technique of dissecting at infundibulum retrieval of stones and cystic duct stump closure with catgut loop there is no significant difference observed retrospectively.

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References

Ja¨rvinen HJ, Ha¨stbacka J. Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg. 1980;191(4):501-5.

Norrby S, Herlin P, Holmin T, Sjödahl R, Tagesson C. Early or delayed cholecystectomy in acute cholecystitis? A clinical trial. Br J Surg.1983;70(3):163-5.

Cooperman AM. Laparoscopic cholecystectomy for severe acute, embedded, and gangrenous cholecystitis. J Laparoendosc Surg. 1990;1(1):37-40.

Cuschieri A. Approach to the treatment of acute cholecystitis: open surgical, laparoscopic or endoscopic? Endoscopy. 1993;25(6):397-8.

Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc. 2006;20(1):82-7.

Siddiqui T, MacDonald A, Chong PS, Jenkins JT. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195(1):40-7.

Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safetyand effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97(2):141-50.

Takada T, Kawarada Y, Nimura Y, Masahiro Y, Toshihiko M, Miho S et al. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Surg. 2007;14(1):1-10.

Miura F, Takada T, Kawarada Y, Yuji N, Keita W, Masahiko H et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):27-34.

Yamashita Y, Takada T, Kawarada Y, Yuji N, Masahiko H, Fumihiko M et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines.J Hepatobiliary Pancreat Surg. 2007;14(1):91-7.

Kitano S, Matsumoto T, Aramaki M, Kawano K. Laparoscopic cholecystectomy for acute cholecystitis. J Hepatobiliary Pancreat Surg. 2002;9(5):534-7.

Maeshiro T, Umekita N. Early laparoscopic cholecystectomy for acute cholecystitis. J Jpn Soc Endosc Surg 2006;11:367-72.

Suzuki K, Kimura T. Scheduled laparoscopic cholecystectomy for acute cholecystitis. J Jpn Soc Endosc Surg. 2006;11:395-8.

Low JK, Barrow P, Owera A, Ammori BJ. Timing of laparoscopic cholecystectomy for acute cholecystitis: evidence to support a proposal for an early interval surgery. Am Surg. 2007;73(11):1188-92.

Hirota M, Takada T, Kawarada Y, Yuji N, Fumihiko M, Koichi H et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):78-82.

Kitano S, Iso Y, Moriyama M, Sugimachi K. A newly designed single dissector useful for laparoscopic cholecystectomy. Surg Endosc. 1992;6(3):144-6.

Yoshida T, Kitano S, Matsumoto T, Bandoh T, Baatar D, Ninomiya K et al. Laparoscopic cholecystectomy in patients undergoing anticoagulant therapy. Surg Today. 1998;28(3):308-12.

Yamashita Y, Kimura T, Matsumoto S. A safe laparoscopic cholecystectomy depends upon the establishment of a critical view of safety. Surg Today. 2010;40(6):507-13.

Popkharitov AI. Laparoscopic cholecystectomy for acute cholecystitis. Langenbecks Arch Surg. 2008;393(6):935-41.

Condilis N, Sikalias N, Mountzalia L, John V, Christos K, Theodoros K et al. Acute cholecystitis: when is the best time for laparoscopic cholecystectomy? Ann Ital Chir. 2008;79(1):23-7.

Lee AY, Carter JJ, Hochberg MS, Alex MS, Stuart LC, Leon HP et al. The timing of surgery or cholecystitis: a review of 202 consecutive patients at a large municipal hospital. Am J Surg. 2008;195(4):467-70.

Watanabe Y, Sato M, Abe Y, Iseki S, Sato N, Kimura S. Preceding PTGBD decreases complications of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis. J Laparoendosc Surg. 1996;6(3):161-5.