Ann Hepatobiliary Pancreat Surg.  2023 Aug;27(3):271-276. 10.14701/ahbps.22-127.

Laparoscopic cholecystectomy for acute cholecystitis: Any time is a good time

• Wani H
• Meher S
• Srinivasulu U
• Mohanty LN
• Modi M
• Ibrarullah M

• KMID: 2545721
• DOI: http://doi.org/10.14701/ahbps.22-127

Abstract

Backgrounds/Aims
Laparoscopic cholecystectomy within one week of acute cholecystitis is considered safe and advantageous. Surgery beyond first week is reserved for non-resolving attack or complications. To compare clinical outcomes of patients undergoing laparoscopic cholecystectomy in the first week and between two to six weeks of an attack of acute cholecystitis.
Methods
In an analysis of a prospectively maintained database, all patients who underwent laparoscopic cholecystectomy for acute cholecystitis were divided into two groups: group A, operated within one week; and group B, operated between two to six weeks of an attack. Main variables studied were mean operative time, conversion to open cholecystectomy, morbidity profile, and duration of hospital stay.
Results
A total of 116 patients (74 in group A and 42 in group B) were included. Mean interval between onset of symptoms & surgery was five days (range, 1–7 days) in group A and 12 days (range, 8–20 days) in group B. Operative time and incidence of subtotal cholecystectomy were higher in group B (statistically not significant). Mean postoperative stay was 2 days in group A and 3 days in group B. Laparoscopy was converted to open cholecystectomy in two patients in each group. There was no incidence of biliary injury. One patient in group B died during the postoperative period due to continued sepsis and multiorgan failure.
Conclusions
In tertiary care setting, with adequate surgical expertise, laparoscopic cholecystectomy can be safely performed in patients with acute cholecystitis irrespective of the time of presentation.

Keyword

Acute cholecystitis; Laparoscopy; Gangrenous cholecystitis

Figure

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  Fig. 1 Flowchart showing the selection of study subjects. OPD, out patient department.

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  Fig. 2 Extracted specimen (gangrenous cholecystitis).

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  Fig. 3 (A, B) Contrast enhanced computed tomography scan showing necrotic gall bladder (GB) wall. (C, D) Intrahepatic abscess caused by GB perforation.

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