An audit of interval cholecystectomy for acute cholecystitis in a low resource healthcare system

Abstract

Early laparoscopic cholecystectomy (ELC) is advocated over open cholecystectomy for acute cholecystitis (AC) as it decreases hospital costs with no increase in morbidity and mortality. The applicability of ELC for AC in a resource limited setting has not been reported. This study reviewed patients with AC at a regional state hospital in South Africa to analyse presentation delays and the related surgical strategies. Adult patients admitted to King Edward VIII Hospital with a diagnosis of AC were included in the study. The admission, operation and discharge records were used to collect data. The severity of the cholecystitis, the time taken to present to the referral facility, the time taken to present to the regional hospital, time to operation, type of operation, conversion rates and complications were evaluated. Early presentation was recorded for two different cut-off times within 72 hours or 7 days of symptom onset. One hundred and thirty-nine patients met the inclusion criteria. The mean age was 47 (range 19-74) years and 86% were female. Forty-nine per cent of patients presented within 7 days and of these only 4.4% presented within 72 hours. A median of 64 days from time of admission to operative intervention was noted. All patients were considered for laparoscopic cholecystectomy (LC); there was a conversion rate of 26%. No major complications were documented. Interval laparoscopic cholecystectomy appears a reliable option in under-resourced healthcare systems.