Timing of Laparoscopic Cholecystectomy for Acute Cholecystitis: A Retrospective Study

Carlos Augusto Cutini, MD, H. Rodolfo Scaravonati, MD, Silvina Lucia Milletari, MD, Patricio E. Donnelly, MD, Nicolas Ortiz, MD, Rodrigo Moran Azzi, MD, FACS, Victor Hugo Serafini, MD, FACS, Gintaras Antanavicius, MD, FACS

Sanatorio Guemes

Introduction: Laparoscopic cholecystectomy has been established as the treatment of choice for the management of acute cholecystitis. Several prospective randomized trials suggest the superiority of early (within 72 h) over the delayed (after a few weeks interval) intervention. This 72 hrs limit, however, is difficult to be kept in many cases for a variety of reasons, referring to both patients and physicians. The speculation of a worse outcome, when attempting laparoscopic cholecystectomy for acute cholecystitis during the urgent admission beyond this very early phase, is experience rather than evidence-based. The aim of the study is to compared the outcome of laparoscopic cholecystectomy performed within and after 72 hours of admission in patients with acute cholecystitis

Methods and Procedures: Retrospective analysis from a prospectively collected database. We include all laparoscopic cholecistectomy in acute cholecystitis, operated before and after 72hrs of Hospital admission.

Results: Between July 2007 and December 2009, Laparoscopic cholecystectomy was performed in 360 patients with acute cholecystitis (178 male, 182 female). The average age was 46 years old (range 21-72 years). Laparoscopic cholecystectomy was performed within 72 hours of admission in 188 patients (group 1) and after 72 hours in 172 patients (group 2). Both groups were matched in terms of age, sex, body mass index, fever, white blood cell count, and ultrasound findings. No significant difference existed in conversion rates between group 1 (6,3%) and group 2 (6,4%). The operation time was 75 versus 100 minutes. Complication rate was 2,12 % versus 3,48%,, and there was significant difference in total hospital stay (3 vs. 8 days). Only one patient required ERCP in group 1 and two in group 2 as a consequence of residual lithiasis. No deaths occurred in this study.

Conclusion: Laparoscopic cholecystectomy for acute cholecystitis performed within the same admission is safe and associated with with acceptable morbidity and extremely low mortality. However, LC should be performed as early as possible, preferably within the golden period of 72 hours after admission

Session: Poster Presentation

Program Number: P370