When Is the Optimal Time for Laparoscopic Cholecystectomy in Gallbaldder Empyema?

Yong Jin Kwon, BS, Hwon Gyeom Park, MD, Kwang Soo Lee, MD, Kyeong Geun Lee, MD. Department of Surgery, College of Medicine, Hanyang University


Purpose: With increasing experience in laparoscopic surgery, early laparoscopic cholecystectomy (LC) is increasingly offered for acute cholecystitis. But early LC without percutaneous transhepatic gallbladder drainage (PTGBD) for gallbladder empyema is believed to be still unsafe. The aim of the present study is to determine optimal time for laparoscopic cholecystectomy in gallbladder empyema.
Methods: A retrospective analysis was made of patients who underwent LC without PTGBD between August 2007 and December 2010 for gallbladder empyema. All cases were confirmed by biopsy. Based on 72 hours, patients were divided into two groups.
Results: LC for gallbladder empyema was performed without PTGBD in 61 patients during the study period. The overall conversion rate was 6.6%. Based on 72 hours, there were 33 patients in the early group and 28 in the delayed group. Comparing patients who underwent early and delayed LC, no significant differences in the rate of operative time (75.5 vs 71.4 min, P=0.537), postoperative hospital stay (4.2 vs 3.3 days, P=0.109), conversion rate (12.1% vs 0%, P=0.118), complication rate (12.1% vs 3.6%, P=0.363) were found between groups. However, the early group had significantly shorter total hospital stay (5.3 vs 8.7 days, P=0.001).
Conclusions: Early LC without PTGBD is safe and feasible for gallbladder empyema and associated with low conversion rate. Delayed LC for gallbladder empyema has no advantages, resulting in longer hospital stay. LC should be performed as soon as possible within 72 hours after admission, to decrease the hospital stay.

Session Number: Poster – Poster Presentations
Program Number: P373
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