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 .
Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Really Safe?
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
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 .