Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Prospective Evaluation of Emergency Versus Delayed Laparoscopic Cholecystectomy for Early Cholecystitis Acute Cholecystitis: Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial (ACDC Study, NCT00447304) Management of acute cholecystitis in the laparoscopic era: Results of a prospective, randomized clinical trial Laparoscopic Cholecystectomy for Acute Cholecystitis: Prospective Trial Comparison of frequency of wound infection: open vs laparoscopic cholecystectomy. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Really Safe? The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study: Multicenter randomized, double-blind, controlled trial of laparoscopic (LC) versus open (LTC) surgery for acute cholecystitis (AC) in adults Laparoscopic Versus Open Cholecystectomy: A Prospective Comparative Study in the Elderly With Acute Cholecystitis Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Early Cholecystectomy Safely Decreases Hospital Stay in Patients With Mild Gallstone Pancreatitis: A Randomized Prospective Study Acute cholecystitis: delayed surgery or observation. A randomized clinical trial. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis Incidence, Risk Factors, and Prevention of Biliary Tract Injuries during Laparoscopic Cholecystectomy in Switzerland Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: Non-operative management is an option in some patients Impact of Choice of Therapeutic Strategy for Acute Cholecystitis on Patient’s Health-Related Quality of Life Percutaneous Drainage versus Emergency Cholecystectomy for the Treatment of Acute Cholecystitis in Critically Ill Patients: Does it Matter? Early minilaparoscopic cholecystectomy in patients with acute cholecystitis.
Background : The role of laparoscopic cholecystectomy for acute cholecystitis is not yet clearly established . The aim of this prospect i ve r and omized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy . Methods : Between January 2001 and November 2002 , 40 patients with a diagnosis of acute cholecystitis were assigned r and omly to early laparoscopic cholecystectomy within 24 h of admission ( early group , n = 20 ) or to initial conservative treatment followed by delayed laparoscopic cholecystectomy , 6 to 12 weeks later ( delayed group , n = 20 ) . Results : There was no significant difference in the conversion rates ( early , 25 % vs delayed , 25 % ) , operating times ( early , 104 min vs delayed , 93 min ) , postoperative analgesia requirements ( early , 5.3 days vs delayed , 4.8 days ) , or postoperative complications ( early , 15 % vs delayed , 20 % ) . However , the early group had significantly more blood loss ( 228 vs 114 ml ) and shorter hospital stay ( 4.1 vs 10.1 days ) . Conclusions : Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible , offering the additional benefit of a shorter hospital stay . It should be offered to patients with acute cholecystitis , provided the surgery is performed within 72 to 96 h of the onset of symptoms OBJECTIVE A prospect i ve r and omized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis . SUMMARY BACKGROUND DATA Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates . It is not known whether there is a role for initial conservative treatment followed by interval elective operation . METHOD During a 26-month period , 99 patients with a clinical diagnosis of acute cholecystitis were r and omly assigned to  early laparoscopic cholecystectomy within 72 hours of admission  ( early group , n = 49 ) or delayed interval surgery after initial medical treatment ( delayed group , n = 50 ) . Thirteen patients ( four in the early group and nine in the delayed group ) were excluded because of refusal of operation ( n = 6 ) , misdiagnosis ( n = 5 ) , contraindication for surgery ( n = 1 ) , or loss to follow-up ( n = 1 ) . RESULTS Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours ( range , 32 to 140 hours ) after admission because of spreading peritonitis ( n = 3 ) and persistent fever ( n = 5 ) . Although the delayed group required less frequent modifications in operative technique and a shorter operative time , there was a tendency toward a higher conversion rate ( 23 % vs. 11 % ; p = 0.174 ) and complication rate ( 29 % vs. 13 % ; p = 0.07 ) . For 38 patients with symptoms exceeding 72 hours before admission , the conversion rate remained high after delayed surgery ( 30 % vs. 17 % ; p = 0.454 ) . In addition , delayed laparoscopic cholecystectomy prolonged the total hospital stay ( 11 days vs. 6 days ; p < 0.001 ) and recuperation period ( 19 days vs. 12 days ; p < 0.001 ) . CONCLUSIONS Initial conservative treatment followed by delayed interval surgery can not reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis . Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy Treatment of acute cholecystitis is still under debate . The aim of this study was to evaluate the efficacy of early laparoscopic cholecystectomy ( ELC ) in comparison with conservative treatment followed by delayed laparoscopic cholecystectomy ( DLC ) in the management of acute cholecystitis . This prospect i ve comparative study involved two groups of patients presenting with acute cholecystitis within 72 hours of the onset of symptoms . ELC was performed in 82 consecutive patients , whereas DLC was performed in 87 patients who previously underwent medical treatment .  Surgical variables , hospital stay , and postoperative morbidity were evaluated in both groups . Time of surgery and conversion rate were lower in the ELC group . Postoperative morbidity was similar in both groups . Overall hospital stay was shorter in the ELC group . ELC within 72 hours of the onset of acute cholecystitis is a safe procedure with better results than DLC in terms of surgical timing , conversion rate , and hospital stay Objective : Acute cholecystitis is a common disease , and laparoscopic surgery is the st and ard of care . Background : Optimal timing of surgery for acute cholecystitis remains controversial : either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics . Methods : The ACDC ( “ Acute Cholecystitis — early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy ” ) study is a r and omized , prospect i ve , open-label , parallel group trial . Patients were r and omly assigned to receive immediate surgery within 24 hours of hospital admission ( group ILC ) or initial antibiotic treatment , followed by delayed laparoscopic cholecystectomy at days 7 to 45 ( group DLC ) . For infection , all patients were treated with moxifloxacin for at least 48 hours . Primary endpoint was occurrence of predefined relevant morbidity within 75 days . Secondary endpoints were as follows : ( 1 ) 75-day morbidity using a scoring system ; ( 2 ) conversion rate ; ( 3 ) change of antibiotic therapy ; ( 4 ) mortality ; ( 5 ) costs ; and ( 6 ) length of hospital stay . Results : Morbidity rate was significantly lower in group ILC ( 304 patients ) than in group DLC ( 314 patients ): 11.8 % versus 34.4 % . Conversion rate to open surgery and mortality did not differ significantly between groups . Mean length of hospital stay ( 5.4 days vs 10.0 days ; P < 0.001 ) and total hospital costs ( & OV0556;2919 vs & OV0556;4262 ; P < 0.001 ) were significantly lower in group ILC . Conclusions : In this large , r and omized trial , laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs . Therefore , we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients . ( NCT00447304 The aim of this prospect i ve , r and omized study was to determine whether laparoscopic cholecystectomy should be performed as an early or a delayed operation in patients with acute cholecystitis . After diagnostic workup , patients were r and omized to one of two groups : ( 1 ) early laparoscopic cholecystectomy  ( i.e. , within 7 days after onset of symptoms ) or ( 2 ) initial conservative treatment followed by delayed laparoscopic cholecystectomy 6 to 8 weeks later .  Seventy-four patients were placed in the early-operation group , and 71 patients were assigned to the delayed-operation strategy . There was no significant difference in conversion rates ( early 31 % vs. delayed 29 % ) , operating times ( early 98 [ range 30 to 355 ] minutes vs. delayed 100 [ 45 to 280 ] minutes ) , or complications . Failure with the conservative treatment strategy was noted in 26 % of these patients . The total hospital stay was significantly shorter in the early group ( 5 [ range 3 to 63 ] days ) vs. the delayed group ( 8 [ range 4 to 50 ] days ; P < 0.05 ) . Despite a high conversion rate , early laparoscopic cholecystectomy offered significant advantages in the management of acute cholecystitis compared to a conservative strategy . The greatest advantage was a reduced total hospital stay Abstract . This prospect i ve study determines the indications for and the optimal timing of laparoscopic cholecystectomy ( LC ) following the onset of acute cholecystitis . It also evaluates preoperative and operative factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy in the presence of acute cholecystitis . Having been established as the procedure of choice for elective cholelithiasis , LC is now also used for management of acute cholecystitis . Under these circumstances the procedure may be difficult and challenging . Certain favorable and unfavorable conditions may be present that influence the conversion and complication rates . Information about these conditions may be helpful for elucidating the optimal circumstances for LC or when the procedure is best avoided . We performed LC on an emergency basis as soon as the diagnosis was made on all patients presenting with acute cholecystitis from January 1994 to December 1995 . All preoperative , operative , and postoperative data were collected on st and ardized forms . Of the 137 patients registered , 130 were eligible for the audit . Seven patients found by laparoscopic intraoperative cholangiography to have choledocholithiasis were converted for common bile duct exploration and were excluded from the study . Altogether 93 patients ( 72 % ) underwent successful LC and 37 ( 28 % ) needed conversion to open cholecystectomy . The conversion rate of acute gangrenous cholecystitis ( 49 % ) was significantly higher than that for uncomplicated acute cholecystitis ( 4.5 % ) ( p < 0.00001 ) and for hydrops ( 28.5 % ) and empyema of the gallbladder ( 28.5 % ) ( p= 0.004 ) . The difference in conversion between the group with acute necrotizing ( gangrenous ) cholecystitis and the two groups with hydrops and empyema of the gallbladder was not statistically significant ( p= 0.07 ) . The complication rates of acute cholecystitis , hydrops , empyema of the gallbladder , and gangrenous cholecystitis were 9.0 % , 9.5 % , 14.0 % , and 20.0 % , respectively ( p= NS ) . Patients with an operative delay of 96 hours or less from the onset of acute cholecystitis had a conversion rate of 23 % , whereas a delay of more than 96 hours was associated with a conversion rate of 47 % ( p= 0.022 ) . The complication rate was 8.5 % in the laparoscopic group and 27 % in the converted group ( p= 0.013 ) . Patients over 65 years of age , with a history of biliary disease , a nonpalpable gallbladder , WBC count over 13,000/cc , and acute gangrenous cholecystitis were independently associated with a high LC conversion rate ; male patients , finding large bile stones , serum bilirubin over 0.8 mg/dl , and WBC count over 13,000/cc were independently associated with a high complication rate following laparoscopic surgery with or without conversion . Generally , LC can be performed safely for acute cholecystitis , with acceptably low conversion and complication rates . Different forms of cholecystitis carry various conversion and complication rates in selected cases . LC for acute cholecystitis should be performed within 96 hours of the onset of disease . Predictors of conversion and complications may be helpful when planning the laparoscopic approach to acute cholecystitis BACKGROUND The objective of this quasi experimental study was to compare the frequency of wound infection between  open cholecystectomy ( OC ) and laparoscopic cholecystectomy ( LC ) conducted in Surgical Unit IV , Jinnah Hospital Lahore from June 2005 to January 2006 . METHODS 100 patients undergoing elective cholecystectomy for symptomatic gallstones were studied . The patients were allocated in the two groups of 50 each by simple r and om technique . Group-I underwent OC and Group-II underwent LC . The patients were then followed up for four weeks to pick up signs of wound infection . In case of infection , the degree of infection and the remedial measures done were documented and the results analysed . RESULTS In LC group there was only one case of Class-II wound infection i.e. 2 % . In case of OC there were three cases of wound infection i.e. 6 % . Out of these , two were of Class-IIl and one of Class-Il . CONCLUSION While there was no wound infection in cases of chronic Cholecystitis in both groups , the frequency of wound infection was three times as common in OC as compared to LC in Acute Cholecystitis/Empyema Background Laparoscopic cholecystectomy is the st and ard treatment for symptomatic gallstones . The quality of the procedure frequently is included in quality improvement programs , but outcome values have not been described to define the st and ard of care for a general population . This study included 20,307 cholecystectomies from a national prospect i ve data base that combines administrative data with clinical data . This report states the quality of  cholecystectomy  in Denmark , establishes benchmarks , and identifies significant risk factors . Methods The Danish Cholecystectomy Data base was queried for data from 2006 to 2009 . The outcome measures included conversion rate , hospital length of stay ( LOS ) , readmission , additional procedures , and 30-day mortality . Patient characteristics and operative findings were analyzed as risk factors using stepwise backward logistic regression . Results The study included 20,307 patients ( 82 % of all cholecystectomies ) . The conversion rate was 7.6 % . Male sex , acute cholecystitis , and previous upper abdominal surgery were risk factors for conversion , with respective odds ratios of 1.50 , 4.61 , and 3.54 . The mean LOS was 1.5 days , and 37.3 % of the patients had same-day surgery . The readmission rate was 9.6 % . Nearly 70 % had a LOS of 1 day or less and no readmission ; 17.3 % had a LOS longer than 3 days and /or readmission ; 5.6 % had an additional procedure within 30 days ; and 0.2 % had a bile duct injury requiring reconstructive surgery . The 30-day mortality rate was 0.27 % . Age older than 60 years , American Society of Anesthesiology ( ASA ) score exceeding 1 , and open procedure were significant risk factors for all the outcomes . Body mass index ( BMI ) was not a risk factor for any of the outcomes . Conclusion The quality of cholecystectomy is high in Denmark , with a low conversion rate and a high frequency of short admissions without readmission . Acute cholecystitis and open procedure are important risk factors for poorer outcomes .The results of this study analyzing a large , unbiased population can be used to benchmark outcomes of cholecystectomy Background . The role of early laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis is not yet established . The aim of our prospect i ve r and omized study was to evaluate the safety and feasibility of early LC for acute cholecystitis and to compare the results with delayed LC . Methods . Between March 2007 to December 2008 , 50 patients with diagnosis of acute cholecystitis were assigned r and omly to early group , n = 25 ( LC within 24 hrs of admission ) , and delayed group , n = 25 ( initial conservative treatment followed by delayed LC , 6–8 weeks later ) . Results . We found in our study that the conversion rate in early LC and delayed LC was 16 % and 8 % , respectively , Operation time for early LC was 69.4 min versus 66.4 min for delayed LC  , postoperative complications for early LC were 24 % versus 8 % for delayed LC  , and blood loss was 159.6 mL early group versus 146.8 mL for delayed group . However early LC had significantly shorter hospital stay ( 4.1 days versus 8.6 days ) . Conclusions . Early LC for acute cholecystitis with cholelithiasis is safe and feasible , offering the additional benefit of shorter hospital stay . It should be offered to the patients with acute cholecystitis , provided that the surgery is performed within 96 hrs of acute symptoms by an experienced surgeon Abstract . The prospect ively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up . The aim of this study was to compare the results of laparoscopic cholecystectomy ( LC ) for acute cholecystitis with that for routine symptomatic gallbladders . The preoperative , intraoperative , and postoperative parameters of 424 routine ( noninflamed ) LCs and 54 LCs for acutely inflamed gallbladders were compared under the “ intention to treat ” principle . Operating time was longer in the inflamed group ( median 97 minutes versus 75 minutes;p < 0.0001 ) . Significantly more adhesions ( 20 % versus 8 % ) , more blood loss ( 48 % versus 19 % ) , a higher incidence of bile spillage ( 28 % versus 12 % ) , and lost stones ( 19 % versus 8 % ) were encountered in patients with acute cholecystitis . Common bile duct ( CBD ) injuries were also more frequent in that group ( 5.5 % versus 0.2%;p = 0.005 ) . The rate of conversion to open surgery was higher than with routine LCs ( 13 % versus 4 % ) . There were two deaths in the routine LC group and none in the acutely inflamed group . There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements . Patients with acute cholecystitis stayed only 1 day longer ( median 4 days versus 3 days ) in hospital . The quality of life scores indicate return to almost normal values by the 14th postoperative day . Long-term follow-up ( 1–3 years ) did not reveal any delayed clinical adverse effects . In summary , LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders . If successfully performed , it has definite benefit for the patient in terms of better postoperative recovery . The trade-off is that the risk of CBD injury is significantly higher Background In some r and omized trials successful laparoscopic cholecystectomy for cholecystitis is associated with an earlier recovery and shorter hospital stay when compared with open cholecystectomy . Other studies did not confirm these results and showed that the potential advantages of laparoscopic cholecystectomy for cholecystitis can be offset by a high conversion rate to open surgery . Moreover in these studies a similar postoperative programme to optimize recovery comparing laparoscopic and open approaches was not st and ardized . These studies also do not report all eligible patients and are not double blinded . Design The present study project is a prospect i ve , r and omized investigation . The study will be performed in the Department of General , Emergency and Transplant Surgery St Orsola-Malpighi University Hospital ( Bologna , Italy ) , a large teaching institutions , with the participation of all surgeons who accept to be involved in ( and together with other selected centers ) . The patients will be divided in two groups : in the first group the patient will be su bmi tted to laparoscopic cholecystectomy within 72 hours after the diagnosis while in the second group will be su bmi tted to laparotomic cholecystectomy within 72 hours after the diagnosis . Trial Registration TRIAL REGISTRATION NUMBER IS RCT N27929536 – The ACTIVE ( Acute Cholecystitis Trial Invasive Versus Endoscopic ) study . A multicentre r and omised , double-blind , controlled trial of laparoscopic versus open surgery for acute cholecystitis in adults The aim of this prospect i ve comparative study was to determine the feasibility and the efficacy of laparoscopic cholecystectomy for acute cholecystitis in patients older than 75 years of age and to compare the results with those of open cholecystectomy . From January 1992 to December 1999 , 139 patients older than 75 years of age underwent cholecystectomy for acute cholecystitis . The two groups of patients with cholecystolithiasis included 50 patients who underwent laparoscopic cholecystectomy ( group 1 ) and 89 patients who underwent open cholecystectomy ( group 2 ) . Group 1 consisted of 30 women and 20 men , with a mean age of 81.9 years ( range , 75–98 ) . Group 2 consisted of 51 women and 38 men , with a mean age of 81.9 years ( range , 75–93 ) . There was no difference in the American Society of Anesthesiologists classification in both groups . The length of the surgery ( 103.3 vs. 149.7 minutes ) , postoperative length of stay ( 7.7 vs. 12.7 days ) , and inpatient rehabilitation ( 15 vs. 42 patients ) were significantly shorter in group 1 than in group 2 . The postoperative morbidity rate was not different between the groups . There was no mortality in group 1 , but four patients died in group 2 ( P = 0.29 ) . The conversion rate was 32 % ( n = 16 ) in group 1 . In summary , laparoscopic cholecystectomy  in elderly patients with acute cholecystitis  is safe and effective .  Laparoscopic cholecystectomy in elderly patients restores them to the best possible quality of life with the lowest cost to them physiologically BACKGROUND Emergency laparoscopic cholecystectomy has been advocated for the treatment of acute cholecystitis ; however it can be a difficult task , especially in public hospitals , with relatively high conversion and complication rates . Percutaneous cholecystostomy is a simple and effective procedure allowing patients to recover from the acute event and undergo elective laparoscopic surgery at a later stage . METHODS We prospect ively assessed a protocol of initial conservative treatment in patients admitted with acute cholecystitis . Patients who did not respond to medical treatment were treated by percutaneous cholecystostomy .  Following discharge the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary . The details of the operation were collected with emphasis on complications and conversion rate . RESULTS During a 3-year period , 224 patients who were admitted with acute calculous cholecystitis entered the protocol . Fifty-four patients did not improve under medical treatment and percutaneous cholecystostomy was performed . In spite of adequate drainage , 5 patients still did not improve : 3 patients were successfully operated upon urgently and recovered , while 2 patients who had severe concomitant diseases and multi-organ failure , died . Forty-nine patients were discharged with the catheter and later re-evaluated for elective operation . In 7 patients common bile duct stones were found and were removed by ERCP prior to the elective operation . Twenty-five patients underwent delayed laparoscopic cholecystectomy with a low conversion rate ( 8 % ) , and only minor complications ( 16 % ) . CONCLUSIONS Conservative treatment and delayed operation is still an acceptable choice in the treatment of acute cholecystitis . Percutaneous cholecystostomy is an effective tool , with high success rate and low morbidity , and allows for better pre-operative evaluation of the biliary system and safe interval laparoscopic surgery . Laparoscopic cholecystectomy after drainage of the gall bladder is a low morbidity procedure with relatively low conversion rate Objective : We hypothesized that laparoscopic cholecystectomy performed within 48 hours of admission for mild gallstone pancreatitis , regardless of resolution of abdominal pain or abnormal laboratory values , would result in a shorter hospital stay . Summary of Background Data : Although there is consensus among surgeons that patients with gallstone pancreatitis should undergo cholecystectomy to prevent recurrence , the precise timing of laparoscopic cholecystectomy for mild disease remains controversial . Methods : Consecutive patients with mild pancreatitis ( Ranson score ≤3 ) were prospect ively r and omized to either an  early laparoscopic cholecystectomy group ( within 48 hours of admission ) versus a control laparoscopic cholecystectomy group ( performed after resolution of abdominal pain and normalizing trend of laboratory enzymes ) . The primary end point was hospital length of stay . Secondary end point was a composite of rates of conversion to an open procedure , perioperative complications , and need for endoscopic retro grade cholangiography . The study was design ed to enroll 100 patients with an interim analysis after 50 patients . Results : At interim analysis , 50 patients were enrolled at a single university-affiliated public hospital . Of them , 25 patients were r and omized to the early group and 25 patients to the control group . Patient age ranged from 18 to 74 years with a median duration of symptoms of 2 days upon presentation and a median Ranson score of 1 . There were no baseline differences between the groups with regards to demographics , clinical presentation , or the presence of comorbidities . The hospital length of stay was shorter for the early cholecystectomy group ( mean : 3.5 [ 95 % CI , 2.7–4.3 ] , median : 3 [ IQR , 2–4 ] ) compared with the control group ( mean : 5.8 [ 95 % CI , 3.8–7.9 ] , median : 4 [ IQR , 4–6 ] [ P = 0.0016 ] ) . Six patients from the early group required endoscopic retro grade cholangiography , compared with 4 in the control group ( P = 0.72 ) . There was no statistically significant difference in the need for conversion to an open procedure or in perioperative complication rates between the 2 groups . Conclusion : In mild gallstone pancreatitis , laparoscopic cholecystectomy performed within 48 hours of admission , regardless of the resolution of abdominal pain or laboratory abnormalities , results in a shorter hospital length of stay with no apparent impact on the technical difficulty of the procedure or perioperative complication rate BACKGROUND The aim of the present study was to compare the risk of observation versus that of cholecystectomy in acute cholecystitis in patients r and omly allocated to delayed operation or conservative treatment . METHODS One-hundred- and -eighty patients were considered for participation in the study ; 71 were excluded according to predefined criteria and 45 did not join for other reasons . The remaining 64 patients were r and omized to cholecystectomy ( n = 31 ) or observation ( n = 33 ) . R and omized patients were contacted regularly and followed up for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Gallstone-related complications or emergency admissions for pain occurred in six patients in the operation group ( 19 % ; 95 % CI 5%-33 % ) and in 12 patients ( 36 % ; 9 % CI 20%-53 % ) in the observation group . Twenty-seven of 31 patients r and omized to cholecystectomy had a  cholecystectomy  at a median of 3.6 months after r and omization , and , of these , 3 ( 11 % ; 95 % CI 0%-23 % ) suffered a major and 7 ( 26 % ; 95 % CI 9%-42 % ) a minor complication . Ten patients r and omized to observation later had their gallbladders removed , 1 ( 10 % ; 95 % CI 0%-29 % ) patient had a major and 1 ( 10 % ; 95 % CI 0%-29 % ) a minor complication . We found no mortality after cholecystectomy . CONCLUSIONS We found a certain risk of subsequent gallstone-related events following conservative treatment of acute cholecystitis , but the data also show that cholecystectomy should not necessarily be compulsory after acute cholecystitis The aim of this prospect i ve r and omized study was to define the optimum management between early and delayed laparoscopic cholecystectomy for patients with acute cholecystitis BACKGROUND Recent management guidelines and r and omised clinical trials have provided evidence -based guidance to the management of acute  biliary pancreatitis and acute cholecystitis . METHODS A question naire was sent to the 1086 members of the Association of Surgeons of Great Britain and Irel and . There were 583 responders ( 54 % ) . RESULTS A policy of cholecystectomy during the index admission or within 4 weeks in fit patients recovering from mild acute biliary pancreatitis was adopted by 58 % of surgeons , and was significantly associated with an upper gastrointestinal and hepato-pancreato-biliary subspecialty interest and a volume of more than 50 cholecystectomies per annum ( OR , 0.43 ; 95 % CI , 0.26 - 0.72 ; P = 0.001 : and OR , 0.46 ; 95 % CI , 0.29 - 0.74 ; P = 0.001 , respectively ) . A policy of urgent cholecystectomy for acute cholecystitis was adopted by 20 % of surgeons , and was significantly associated with an upper gastrointestinal/hepato-pancreato-biliary subspecialty interest and the ' routine ' adoption of laparoscopic approach to  cholecystectomy  ( OR , 0.34 ; 95 % CI , 0.19 - 0.60 ; P < 0.001 : and OR , 0.51 ; 95 % CI , 0.3 - 0.86 ; P = 0.01 , respectively ) . CONCLUSIONS The management of cholelithiasis in patients with acute biliary pancreatitis in the UK remains suboptimal . Moreover , only a minority of surgeons offer patients presenting with acute cholecystitis the benefits of early laparoscopic cholecystectomy . The management of acute biliary disease may be improved if these cases were concentrated in the h and s of surgeons with upper gastrointestinal/hepato-pancreato-biliary interest and those who perform laparoscopic cholecystectomy regularly The aim of this prospect i ve trial was to determine whether surgical approach ( open versus laparoscopic ) had an impact on morbidity and postoperative recovery after cholecystectomy for acute cholecystitis Abstract . Bile duct injury ( BDI ) during  laparoscopic cholecystectomy ( LC )  which may result in patient disability or death are reported to occur more frequently when compared to open surgery . The aim of this nationwide prospect i ve study beyond the laparoscopic learning curve was to analyze the incidence , risk factors , and management of major BDI . During a 3-year period ( 1995–1997 ) 130 items of all LC data were collected on a central computer system from 84 surgical institutions in Switzerl and by the Swiss Association of Laparoscopic and Thoracoscopic Surgery and evaluated for major BDIs . Simple biliary leakage was excluded from analysis . There were 12,111 patients with a mean age of 55 years ( 3–98 years ) enrolled in the study .  The overall BDI incidence was 0.3 % , 0.18 % for symptomatic gallstones , and 0.36 % for acute cholecystitis . In cases of severe chronic cholecystitis with shrunken gallbladder , the incidence was as high as 3 % . Morbidity and mortality rates were significantly increased in BDIs . BDI was recognized intraoperatively in 80.6 % , in 64 % of cases by help of intraoperative cholangiography . Immediate surgical repair was performed laparoscopically ( suture or T-drainage ) in 21 % ; in 79 % , open repair ( 34 % simple suture , 66 % Roux-en-Y reconstruction ) was needed . The BDI incidence did not decrease during the last 7 years . In 47 % , BDIs were caused by experienced laparoscopic surgeons , perhaps because they tend to operate on more difficult patients . In conclusion , the incidence of major BDIs remains constant in Switzerl and at a level of 0.3 % , which is still higher when compared to open surgery . However , most cases are now detected intraoperatively and immediately repaired which ensures a good long-term outcome . For preventing such injuries , exact anatomical knowledge with its variants and a meticulous surgical dissecting technique especially in case of acute inflammation or shrunken gallbladder are m and atory Abstract Background . Cholecystectomy is routinely recommended to prevent recurrent disease after an initial episode of acute cholecystitis . Therefore , r and omized controlled trials have mainly focused on the timing of surgery , but many patients scheduled for cholecystectomy have deferred surgery with long periods of symptom-free intervals . Our present aim is to examine the long-term feasibility and safety of observation compared with surgery . Methods . Trial of 64 patients with acute cholecystitis previously r and omized to observation or cholecystectomy  , which examined outcome in terms of completed r and omized treatment and appearance of further symptoms and the need for surgical treatment .  Thirty-three patients were r and omized to observation and 31 patients to cholecystectomy .  Median follow-up was 14 years . Results . Of the 33 patients r and omized to observation , 11 ( 33 % ) experienced a new event of gallstone-related disease ( eight ( 24.2 % ) had acute cholecystitis ) and 11 ( 33 % ) were operated . No significant difference ( p = 0.565 ) was found between the two r and omized groups with regard to recurrent disease or complications . Virtually no surgery took place after 5 years of follow-up . The difference in completed r and omized treatment between the groups was not significant ( p = 0.077 ) . Long-term mortality was equal in those operated and in those observed . Conclusions . Twenty-four percent of the patients experienced recurrent cholecystitis , but escalation of disease severity or increased mortality was not observed . Long-term observation after acute cholecystitis was feasible in two-thirds of the patients as the risk for recurrent disease was negligible after 5 years Background : The aim of this prospect i ve , r and omized study was to determine if health related quality of life is affected by the choice of surgical strategy in the management of acute cholecystitis . Material and Methods : After diagnostic workup , patients were r and omized to one of two groups : ( 1 ) early laparoscopic cholecystectomy  ( i.e. within 7 days after onset of symptoms ) or ( 2 ) initial conservative treatment followed by delayed laparoscopic cholecystectomy .  Seventy-four patients entered the early operation group and 71 patients were assigned to the delayed  operation  strategy . Assessment s of quality of life were made at 1 , 3 and 6 months after surgery , and in the delayed operation group also one month after the initial conservative treatment . Results : The gastrointestinal symptom scores were significantly better in three dimensions ( diarrhea , indigestion , abdominal pain ) one month after surgery for the acute operation group ( p < 0.01 ) . Three and 6 months after the operation we were unable to detect any significant differences between the groups . The patients in the delayed operation group did not appear to suffer from more symptoms in the period of time waiting for their elective operation . Psychological general well-being showed no major differences between the groups . Conclusion : Cholecystectomy in the acute phase of acute cholecystitis offers a significant reduction of gastrointestinal symptoms during the first postoperative month and to that associated improved quality of life in this group of patients Background The aim if this study was to compare percutaneous drainage ( PD ) of the gallbladder to emergency cholecystectomy ( EC ) in a well-defined patient group with sepsis related to acute calculous/acalculous cholecystitis ( ACC/AAC ) . Methods Between 2001 and 2007 , all consecutive patients of our ICU treated by either PD or EC were retrospectively analyzed . Cases were collected from a prospect i ve data base . Percutaneous drainage was performed by a transhepatic route and EC by open or laparoscopic approach . Patients ’ general condition and organ dysfunction were assessed by two vali date d scoring systems ( SAPS II and SOFA , respectively ) . Morbidity , mortality , and long-term outcome were systematic ally review ed and analyzed in both groups . Results Forty-two patients [ median age = 65.5 years ( range = 32–94 ) ] were included ; 45 % underwent EC  ( ten laparoscopic , nine open ) and 55 % PD ( n = 23 ) . Both patient groups had similar preoperative characteristics .  Percutaneous drainage and EC  were successful in 91 and 100 % of patients , respectively . Organ dysfunctions were similarly improved by the third postoperative/postdrainage days . Despite undergoing PD , two patients required EC due to gangrenous cholecystitis . The conversion rate after laparoscopy was 20 % . Overall morbidity was 8.7 % after PD and 47 % after EC ( P = 0.011 ) . Major morbidity was 0 % after PD and 21 % after EC ( P = 0.034 ) . The mortality rate was not different ( 13 % after PD and 16 % after EC , P = 1.0 ) and the deaths were all related to the patients ’ preexisting disease . Hospital and ICU stays were not different . Recurrent symptoms ( 17 % ) occurred only after ACC in the PD group . Conclusions In high-risk patients , PD and EC are both efficient in the resolution of acute cholecystitis sepsis . However , EC is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible . Percutaneous drainage represents a valuable intervention , but secondary cholecystectomy is m and atory in cases of acute calculous cholecystitis BACKGROUND Recently , techniques using fine-caliber instruments ( 2 or 3 mm in diameter ) for laparoscopic cholecystectomy , called minilaparoscopic cholecystectomy ( MLC ) , were reported to be superior to conventional LC ( CLC , using 5 mm instruments ) in postoperative course and cosmetic outcome . However , the use of MLC to date has been largely restricted to uncomplicated situations . Since CLC has been proved to be a safe and efficient technique for acute cholecystitis especially if conducted early , this study tests the feasibility and safety of MLC for acute cholecystitis . METHODS Sixty-nine consecutive patients with acute cholecystitis were prospect ively r and omized to  minilaparoscopic  ( n = 38 ) or conventional laparoscopic  ( n = 31 )  cholecystectomy  , and the operations were conducted within 2 days of admission whenever possible . Despite different operative techniques , both groups of patients received identical preoperative preparation , evaluation and postoperative care . The two groups were compared for patient characteristics , results of laboratory tests , predictive score for LC difficulties , operative time , operative complications , hospitalization days and need for meperidine injection for wound pain . RESULTS The conversion rate was 7.9 % ( 3 of 38 ) for the MLC group and 6.5 % ( 2 of 31 ) for the CLC group . Nine patients in the  MLC group and 7 in the CLC group had concomitant choledocholithiasis and underwent endoscopic stone retrieval  before operation . The age , sex , predictive score for LC difficulties , preoperative leukocyte count , length of hospital stay and requirement of intramuscular meperidine injections were similar for both groups of patients , while , the operative times were marginally longer in the MLC group ( 113.8 + /- 30.8 versus 98.2 + /- 33.2 minutes , P = 0.056 ) . No major complications occurred in either group . CONCLUSIONS The results of cholecystectomy for acute cholecystitis by MLC are as good as those of CLC if the operation is performed early , with obvious smaller incisions and minimal complications . MLC is a safe and effective procedure for patients with acute cholecystitis , and has an acceptable low conversion rate
Early laparoscopic cholecystectomy during acute cholecystitis seems safe and shortens the total hospital stay .
BACKGROUND Gallstones are present in about 10 % to 15 % of the adult western population .
Between 1 % and 4 % become symptomatic in a year .
Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis .
OBJECTIVES The aim was to compare the early laparoscopic cholecystectomy ( less than seven days of onset of symptoms ) versus delayed laparoscopic cholecystectomy ( more than six weeks after index admission ) with regards to benefits and harms .