Any Time Laparoscopic Cholecystectomy in Moderate to Severe Acute Cholecystitis without Septic Shock

Abstract

Introduction: There is an ongoing debate over the timings of laparoscopic cholecystectomy in acute cholecystitis. Most authors recommend surgery within the first 72 hours. We offer laparoscopic cholecystectomies in every patient with acute cholecystitis regardless of the timing of presentation. Material and methods: We prospectively analyzed outcomes of our protocol of any time acute cholecystitis. We perform laparoscopic cholecystectomies within the first 24 hours of presentation to us without considering time since attack if the patient is not in septic shock where we follow survival sepsis guidelines. Results: We performed 110 laparoscopic cholecystectomies between April, 2019-March, 2020. We prefer single-dose preoperative antibiotics (third-generation cephalosporin) in all laparoscopic cholecystectomies. A total of 79 patients were having acute cholecystitis. 67 patients were having grade 2 and 12 patients were having grade 3 cholecystitis according to Tokyo guidelines. 50 patients were presented more than 72 hours after the attack. 21 patients presented more than 48 hours but less than 72 hours. 8 patients presented within 24 hours. The mean duration of the presentation was 120 hours. 5 patients presented after more than 7 days. One patient was having grade 3 cholecystitis and was having septic shock so he was managed with percutaneous cholecystostomy and according to survival sepsis, protocol and lap choly were done after 72 hours. Out of 79 patients included in the study, 2 patients were converted to open; in 3 patients we performed lap subtotal cholecystectomy due to difficult calot triangle. Out of these only 2 patients developed port site infection and 3 patients developed bilioma which was managed by percutaneous drainage. All patients were discharged the same day or the next day. Only two patients with bilioma were readmitted. Rest all of the patients had an uneventful recovery. Conclusion: There is no need to strictly follow the 72-hour time limit for laparoscopic cholecystectomy in acute cholecystitis. Any time laparoscopic cholecystectomy should be the rule inexperienced centre.