DOI: http://dx.doi.org/10.18203/2349-2902.isj20184093

Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a comparative study

Rahul Chhajed, Ramesh Dumbre, Arun Fernandes, Deepak Phalgune

Abstract


Background: Laparoscopic cholecystectomy is now the procedure of choice for patient presenting with acute cholecystitis unless it is contraindicated for technical reason or safety. An attempt was made to compare the outcome and postoperative complications of early vs delayed laparoscopic cholecystectomy in acute cholecystitis.

Methods: Fifty patients aged 18 to 64 years having acute cholecystitis admitted for laparoscopic cholecystectomy were included. They were divided into two groups, early (less than 72 hours) and delayed (more than 72 hours up to 6 weeks) laparoscopic cholecystectomy. The patients were followed for three months after the surgery. The primary outcome measures were conversion to open surgery and postoperative complications whereas secondary outcome measures were hospital stay and return to full activity. Comparison of quantitative variables and qualitative variables was done using unpaired student’s “t” test and chi-square test/ Fisher’s exact test respectively.

Results: Conversion to open cholecystectomy (p = 0.007) and post-operative complications (p = 0.032) were significantly less in early laparoscopic cholecystectomy group compared to delayed laparoscopic cholecystectomy group. Mean days of hospital stay (4.9 versus 7.4 with p = 0.001) and mean days of return to full activities (12.6 vs 16.3 days with p = 0.001) was significantly less in early laparoscopic surgery group compared to delayed laparoscopic cholecystectomy group. Mean duration of surgery was significantly less in early laparoscopic surgery group as compared to delayed laparoscopic surgery group (69.3 versus 108.5 minutes, with p = 0.001).

Conclusions: Early laparoscopic cholecystectomy is better choice than delayed laparoscopic cholecystectomy in acute cholecystitis.


Keywords


Acute cholecystitis, Conversion to open surgery, Duration of hospital stay, Laparoscopic cholecystectomy, Post-operative complications

Full Text:

PDF

References


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

Järvinen HJ, Hästbacka J. Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg. 1980;191:501.

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;195:40-7.

Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Sekimoto M, et al. Background: Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreatic Sci. 2007;14:1-0.

Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC et al. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. British J Surg. 1998;85:764-7.

Soper NJ, Stockmannpt, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg. 1992;127:917-21.

Jarrar MS, Chouchène I, Fadhl H, Ghrissi R, Elghali A, Ferhi F, et al. Early versus delayed laparoscopic cholecystectomy for lithiasic acute cholecystitis during emergency admissions. results of a monocentric experience and review of the literature. Tunis Med. 2016;94:519-24.

Uysal E, Turel KS, Sipahi M, Isik O, Yilmaz N, Yilmaz FA. Comparison of early and interval laparoscopic cholecystectomy for treatment of acute cholecystitis. Which is better? A multicentered study. Surgical Laparoscopy Endoscopy Percutaneous Techniques. 2016;26:e117-21.

Chang TC, Lin MT, Wu MH, Wang MY, Lee PH. Evaluation of early versus delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis. Hepato-Gastroenterol. 2009;56:26-8.

Zhou MW, Gu XD, Xiang JB, Chen ZY. Comparison of clinical safety and outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Sci World J. 2014;14:2014.

Rouf Gul RA, Sheikh RA, Salroo NA, Matoo AR, Wani SH. Comparison of early and delayed laparoscopic cholecystectomy for acute cholecystitis: experience from a single center. North Am J Med Sci. 2013;5:414.

Minutolo V, Licciardello A, Arena M, Nicosia A, Di Stefano B, Calì G, et al. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of outcomes and costs between early and delayed cholecystectomy. Eur Rev Med Pharmacol Sci. 2014;18:40-6.

Garber SM, Korman J, Cosgrove JM, Cohen JR. Early laparoscopic cholecystectomy for acute cholecystitis. Surgical endoscopy. 1997;11:347-50.

Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998;227:461.

Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointestinal Surg. 2003;7:642-5.

Madan AK, Aliabadi-Wahle S, Tesi D, Flint LM, Steinberg SM. How early is early laparoscopic treatment of acute cholecystitis? Am J Surg. 2002;183:232-6.