Current Perspective of Laparoscopic Cholecystectomy for Acute Cholecystitis

Abstract

Background: Acute cholecystitis is a potentially life-threatening condition, which affects >5 million Egyptian yearly and causes high economic burden around the world. Gallstones are the major contributor to acute cholecystitis. Laparoscopic cholecystectomy (LC) is an important approach for treating acute cholecystitis nowadays. Issued data indicated that approximately 600,000 LCs and >30,000 LCs were annually performed to treat acute cholecystitis in the Egypt. Although LCs have been extensively performed to manage acute cholecystitis, the optimal timing of LC for this given condition is inconclusive. Aim of the Study: To highlight the optimal time for LC in acute cholecystitis, comparing ELC or DLC is better in terms of surgical complications as bile duct injury, bile leakage, cystic artery bleeding, conversion to open surgery, duration of the surgery. Patients and Methods: This study was done on 30 patients in Ain Shams University Hospitals in 12 months duration starting from June 2017 to June 2018 reviewing reports on ELC vs. DLC with all patients received medical treatment as antibiotics (3rd generation cephalosporins) and proper analgesia for 48-72 hours and if the patient responded to medical treatment so he/she was go with DLC group and if no response, he/she was go ELC group. This study was classified into two groups: Group (A) underwent laparoscopic cholecystectomy in the first seventy two hours from the onset of symptoms. Group (B) underwent laparoscopic cholecystectomy after delayed interval of six to eight weeks after initial period of conservative treatment. Results: The mean operative time (100.3 ± 14.75 minutes) in the early group was more than the mean operative time (80.3 ± 12.4 minutes) in the delayed group. The conversion rate to open cholecystectomy (6.7%) in the early group was less than the conversion rate (13.3%) in the delayed group. The mean total hospital stay (4.8 ± 0.91 days) in the early group was less than the mean total hospital stay (9.2 ± 1.61days) in the delayed group. Finally, the overall complications in (53%) the early group were slightly more than complications occurred (47%) in the delayed group. Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis within 72 hours has been shown to be superior to late or delayed cholecystectomy as regard the outcome and cost of treatment. Laparoscopic cholecystectomy should be carried out as soon as the diagnosis of acute cholecystitis is established and preferably before 3 days following the onset of symptoms. Early laparoscopic cholecystectomy can reduce both the conversion rate and the total hospital stay as medical and economic benefits.