Is it Safe to Perform Laparoscopic Cholecystectomy for Acute Calculus Cholecystitis within 7 Days Following Symptom Onset?

Rajesh Poudel

doi:10.31729/jnma.3655

Abstract

Although operation within "golden 72 hours" from the onset of symptoms has been suggested for acute calculus cholecystitis, such early surgery is hardly possible in clinical practice because of variable timing of presentation. The aim of this study is to compare the outcomes of patients undergoing laparoscopic cholecystectomy within 72 hours of symptom onset with patients undergoing surgery after 72 hours up to 7 days of symptom onset for acute calculus cholecystitis. This is a descriptive cross-sectional study carried out from November 2016 to July 2018. Patients with acute calculus cholecystitis were divided in two groups according to the onset of symptoms. Main outcomes measured were conversion rate, duration of surgery, length of hospital stay and intraoperative complications. Total 64 patients were evaluated. Among which 18 (28.1%) underwent surgery within 72 hours of onset of symptom. Around 46 (71.9%) underwent surgery after 72 hours of symptom onset. On bivariate analysis there were no significant differences in mean duration of surgery, hospital stay and conversion to open surgery between two groups. Early laparoscopic cholecystectomy is a safe procedure when done within 7 days of symptom onset. There were no significant difference in conversion rate, operative time, hospital stay, morbidity and mortality.

Highlights

Operation within “golden 72 hours” from the onset of symptoms has been suggested for acute calculus cholecystitis, such early surgery is hardly possible in clinical practice because of variable timing of presentation
The diagnosis and assessment of acute cholecystitis were performed in accordance with the diagnostic criteria of the Revised Tokyo Guidelines published in 2013.9 All patients diagnosed with acute calculus cholecystitis were included in the study
Our study showed no significant differences in regard to conversion to open surgery, length of hospital stay, surgical site infection and duration of surgery in these two groups

Summary

Introduction

Operation within “golden 72 hours” from the onset of symptoms has been suggested for acute calculus cholecystitis, such early surgery is hardly possible in clinical practice because of variable timing of presentation. Studies have indicated early laparoscopic surgery to be a safe option in acute cholecystitis.[3,4,5,6,7,8] Laparoscopic cholecystectomy is considered to be the standard of care if the patient is seen within 72 hours of the attack.[6] operation within the “golden 72 hours” from the onset of symptoms has been suggested, such early surgery is hardly possible in clinical practice because of variable timing of presentation

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