Abstract
Abstract Aims This study aims to assess outcomes of laparoscopic cholecystectomy (LC) performed in patients presenting with acute cholecystitis or symptomatic gallstone disease within 7 days of onset of symptoms compared to 7 days of diagnosis. Methods A prospective case note analysis was conducted for all patients undergoing laparoscopic cholecystectomy in a tertiary center between February and April, 2018. Outcome measures were compared between 2 patient cohorts: A- those undergoing laparoscopic cholecystectomy within 7 days of diagnosis and B-within 7 days of onset of symptoms. Results 86 patients met inclusion criteria. The mean duration between LC and diagnosis was 5 days, and 16 patients (18%) had surgery over a week after diagnosis. The mean duration between LC and symptom onset was 9 days, and 44 patients (51%) underwent LC over 7 days after symptom-onset. There was a statistically significant reduction in the number of pre-operative ERCPs(p-0.08) and MRCPs(p<0.01) in patients of group B compared to A. A similar decline was noted in surgery length(p<0.01) and incidence of complicated gallbladder disease (characterised by adhesions, empyema, retrograde dissection, perforation, necrosis, pancreatitis) (p<0.01) in the former group when measured against the latter. We further observed significantly better post-operative outcome in group A with reduced rates of complications(p<0.01) (urinary retention, bile leak and hepatic artery pseudoaneurysm) and readmission(p-0.03). Conclusions This is the first study to demonstrate the advantages of using symptom onset to guide practice, and whilst higher power studies are needed to confirm our findings, could represent the beginning of an important shift.
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