Early Laparoscopic Cholecystectomy for Acute Cholecystitis in Accordance with the Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis

Abstract

Aims: To determine if early laparoscopic cholecystectomy (LC) for acute cholecystitis, performed in accordance with the Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis, was more effective than delayed LC. Methodology: We compared surgical difficulties, clinical courses and complications between 32 patients undergoing delayed LC and 30 undergoing early LC. Results: Delayed LC was associated with more surgical difficulties than early LC, including severe adhesion of the greater omentum (15/32 vs. 1/30), severe cicatrization of Calot’s triangle (15/32 vs. 3/30), inability to identify or skeletonize the cystic duct (18/32 vs. 3/30), and severe cicatrization of the gallbladder bed (27/32 vs. 1/30). Delayed LC was also associated with longer operating times (163 vs. 93 minutes), more conversions to open surgery (7/32 vs. 0/30), more complications (3/32 vs. 1/30), and longer hospitalization (30.5 vs. 10.2 days). Most early LCs was performed during overtime. Conclusions: Despite the retrospective nature of this study, the results demonstrated that changing treatment for acute cholecystitis from delayed to early LC, in accordance with the Tokyo Guidelines, could effectively reduce operation time, duration of symptoms and hospital stay, and thus be of significant benefit to patients. Further, prospective studies are needed to confirm these findings.