Early versus delayed laparoscopic cholecystectomy with and without percutaneous drainage for complicated acute calculous cholecystitis: A prospective randomized study

Abstract

Objective: The purpose of this research was to compare surgical consequences of early versus delayed laparoscopic cholecystectomy for complicated acute calculous cholecystitis. Patients and Methods: This prospective randomized work was conducted on 150 patients complaining of complicated acute calculous cholecystitis; presented to the Emergency Department, Alexandria Main University Hospital, Egypt, between January 2011 and January 2017. They were distributed randomly into two groups (75 patients each): Group (A) for early laparoscopic cholecystectomy and Group (B) for delayed laparoscopic cholecystectomy. Results: There were 42 men and 108 women. Their mean age at diagnosis was 39.6±10.27 years. The timing of surgery since onset of patients’ complains was ranged from 1.0 to 7.0 days in Group A and from 6 to 10 weeks in Group B. Acute abdominal pain was present in both groups patients. Preoperative CT scan was done for 60 patients (40%) to verify the presence of complications. The mean operative time in Group A and Group B patients were 71.0±26.93 and 38.0±26.25 minutes respectively and there was a statistically significant difference (p>0.054). Laparoscopic cholecystectomy was converted to open procedure in ten patients. The mean hospital stay in patients of Group A was 1.76±1.05 while in patients of Group B was 3.87±2.43 in the first admission and 2.72±1.41 in second admission. There was no major bile duct injury or post-operative obstructive jaundice in either group. In six patients (2 in Group A and 4 in Group B) bile leak was noted from the drain and port sites’ infections were found in eight patients. Conclusion: Early laparoscopic cholecystectomy one week from start of symptoms of complicated acute calculous cholecystitis; was safe, feasible, and considered an acceptable indication.