Susanna Mazzocato, MD1, Angela Maurizi, MD2, Damiana Mandriani, MD2, Fernando De Rose, MD2, Roberto Campagnacci, MD, PhD2. 1Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy, 2General Surgery, ASUR Regione Marche, “Carlo Urbani” Hospital, Jesi, Italy
INTRODUCTION: The standard treatment for lithiasic acute cholecystitis remains the laparoscopic cholecystectomy despite the timing of surgery is still controversial. The aim of this prospective study is to evaluate the advantages and limitations of early laparoscopic cholecystectomy in a district hospital.
METHODS AND PROCEDURE: All patients undergoing laparoscopic cholecystectomy at the Surgical Department of “Carlo Urbani” Hospital in Jesi (Italy) from May to September 2017 were consecutively enrolled. Clinical data such as gender, age, BMI, comorbidity, previous abdominal surgery, previous acute cholecystitis were collected. Subsequently, the patients were arranged in two groups according to the timing of intervention (early versus elective surgery). For each group, we compared data concerning surgery, such as operative time, intraoperative and postoperative complications, length of hospital stay and cost analysis.
RESULTS: This study is a part of an ongoing research. So far, we collected 67 laparoscopic cholecystectomies. Ten (15%) of them were admitted with acute cholecystitis and were operated during the hospital stay (group A). Group B included patients scheduled for elective surgery (n= 57; 85%). The two groups were comparable with respect to clinical data. Conversion to open approach was performed in 3 cases, all of them in group B. Mean surgical time was 67.5 ± 22.01 minutes in group A and 62.4 ± 19.77 minutes in group B (p= 0.494). No significant differences in intraoperative and postoperative complications rates were seen in the two groups, just a few in both of them. Mean overall length of hospitalization was 6.4 ± 3.89 days in group A and 2 ± 1.63 days in group B (p= 0.001), whereas the difference in length of postoperative hospitalization was not statistically significant. Due to the extended hospitalization for group A, the cost increase as compared to group B was statistically significant, too.
CONCLUSIONS: Early laparoscopy is comparable to delayed laparoscopy in terms of postoperative hospitalization and complications in the management of acute cholecystitis. A longer hospital stay among patients scheduled for immediate surgery may be associated with a more time-consuming diagnostic work-up before surgery. However, in future research we expect to enhance our cost analysis with more data regarding the costs incurred in the first hospitalization reserved to non-operative treatment of group B inpatients with acute cholecystitis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86797
Program Number: P087
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster