Late Laparoscopic Cholecystectomy Research Articles

Incidence of Complications in Early vs. Late Laparoscopic Cholecystectomy after Acute Cholecystitis

Background: The majority of digestive tract illnesses are caused by biliary ailments. Cholelithiasis is one of them,that produces generalized illness, necessitating surgical intervention for complete recovery. Aims: The goal ofthis study was to compare the outcomes of early (within one week) and delayed (after six weeks) laparoscopiccholecystectomy for acute cholecystitis.Patients and Methods: This study was took place from November 2019 to July 2021, at the General Surgerydepartment, Beni-Suef University hospitals, with 54 cases diagnosed with acute cholecystitis during the studyperiod were included. Patients were randomized using the closed envelope method.Results: Operative time showed significant prolongation in the delayed group (76.12 vs. 37.98 minutes in the earlygroup – p < 0.001).Early intervention was associated with a significant reduction in post-operative pain measuredby VAS (3 vs. 4 in the other group – p = 0.015). Patient satisfaction was significantly improved in the early groupcompared to the late group (p < 0.001).Conclusion: This study found that laparoscopic cholecystectomy at early stage is a safe and feasible therapeuticoption for cholecystitis. It’s linked to lower VAS scores, shorter operative times, and lower complication rates. It’snot statistically significant, but related to higher patient satisfaction.

Evaluation of early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis: a prospective, randomized study.

Uncertainty exists about whether early laparoscopic cholecystectomy (LC) is an appropriate surgical treatment for acute calculous cholecystitis. This study aimed to compare early vs. late LC for acute calculous cholecystitis regarding intraoperative difficulty and postoperative outcomes. This was a prospective randomized study carried out between December 2015 and June 2017; 60 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 30 patients. Thirty patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other 30 patients were placed in the delayed group, first treated conservatively, and followed by LC 3 to 6 weeks later. The conversion rates in both groups were 6.7% and 0%, respectively (p = 0.143). The operating time was 56.67 ± 11.70 minutes in the early group and 75.67 ± 20.52 minutes in the delayed group (p = 0.001), and both groups observed equal levels of postoperative complications. Early LC patients, on the other hand, required much fewer postoperative hospital stay (3.40 ± 1.99 vs. 6.27 ± 2.90 days, p = 0.006). Considering shorter operative time and hospital stay without significant increase of open conversion rates, early LC might have benefits over late LC.

A Retrospective Comparative Study Between Early (≤ 72 hrs) and Late (> 72 hrs) Laparoscopic Cholecystectomy after ERCP in St. Paul’s Hospital Iloilo

Objective: The study was performed to assess and compare the effect of early (≤ 72 hours) and late (>72 hours) laparoscopic cholecystectomy after Endoscopic retrograde cholangio pancreatography (ERCP) in terms of duration of operation, conversion to open cholecystectomy, intraoperative complicating factors, duration of hospital stay from the date of ERCP, hospital expenses, and presence of postoperative complications. Methods: This is a retrospective study from 2010 up to July 2019. Outcomes (duration of operation, rate of conversion, intraoperative complicating factors, length of hospital stay, hospital expenses and post-operative complications) were compared between patients who had ERCP then cholecystectomy within 72 hours (Early Group) and those who had ERCP then cholecystectomy after more than 72 hours (Late Group). Results: A total of 19 patients were included in this study. There were 10 patients in the Early Group and 9 in the Late Group. Early laparoscopic cholecystectomy after ERCP had a shorter statistically significant duration of hospital. Shorter operative time, fewer intraoperative complicating factors, no conversion to open cholecystectomy, cheaper hospital expenses and no post-operative complications were also noted in the Early Group as compared to the Late Group. Conclusion: Early laparoscopic cholecystectomy is safe and results in a shorter hospital stay compared to late laparoscopic cholecystectomy. Key words: early laparoscopic cholecystectomy, cholecystectomy after ERCP, choledocholithiasis, cholecystolithiasis

Is early laparoscopic cholecystectomy after clearance of common bile duct stones by endoscopic retrograde cholangiopancreatography superior?: A systematic review and meta-analysis of randomized controlled trials.

With medical advancement, common bile duct stones were treated by endoscopic retrograde cholangiopancreatography (ERCP), considered the standard treatment. However, ERCP might induce complications including pancreatitis and cholecystitis that could affect a subsequent laparoscopic cholecystectomy (LC), leading to conversion to open cholecystectomy perioperative complications. It is not yet known whether or not the time interval between ERCP and LC plays a role in increasing conversion rate and complications. Bides, in the traditional sense, after ERCP, for avoiding edema performing LC was several weeks later. Even no one study could definite whether early laparoscopic cholecystectomy after ERCP affected the prognosis or not clearly. Comparing some different surgical timings of LC after ERCP. Searching databases consist of all kinds of searching tools, such as Medline, Cochrane Library, Embase, PubMed, etc. All the included studies should meet the demands of this meta-analysis. In all interest outcomes below, we took full advantage of RevMan5 and WinBUGS to assess; the main measure was odds ratio (OR) with 95% confidence. Moreover, considering the inconsistency of the specific time points in different studies, we set a subgroup to analyze the timing of LC after ERCP. For this part, Bayesian network meta-analysis was done with WinBUGS. In the pool of conversion rate, the result suggested that the early LC group was equal compared with late LC (OR = 0.68, I2 = 0%, P = .23). Besides, regarding morbidity, there was no significant difference between the 2 groups (OR = 0.74, I2 = 0%, P = .26). However, early LC, especially for laparoscopic-endoscopic rendezvous that belonged to performing LC within 24 hours could reduce the post-ERCP pancreatitis (OR = 0.16, I2 = 29%, P = .0003). Considering early LC included a wide time and was not precise enough, we set a subgroup by Bayesian network, and the result suggested that performing LC during 24 to 72 hours was the lowest conversion rate (rank 1: 0%). In the present study, LC within 24 to 72 hours conferred advantages in terms of the conversion rate, with no recurrence of acute cholecystitis episodes.

Early versus late laparoscopic cholecystectomy in acute biliary pancreatitis: a prospective randomised study

Background: In patients with acute biliary pancreatitis, cholecystectomy is mandatory to prevent further biliary events, but the precise timing of cholecystectomy for mild to moderate disease remain a subject of ongoing debate. The aim of this study is to assess the outcomes of early versus delayed cholecystectomy. We hypothesize that early cholecystectomy as compared to delayed cholecystectomy reduces recurrent biliary events without a higher peri-operative complication rate.Methods: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.Results: A total of 70 patients were enrolled at tertiary care hospital in central India. Of them, 35were randomized to the early group and 35 patients to the delayed group using simple randomization technique. Conclusions: In mild to moderate ABP, early laparoscopic cholecystectomy reduces the risk of recurrent biliary events without an increase in operative difficulty or perioperative morbidity.

Comparison of Early and Late Laparoscopic Cholecystectomy Results in the Treatment of Mild and Moderate Acute Biliary Pancreatitis

Comparison of Early and Late Laparoscopic Cholecystectomy Results in the Treatment of Mild and Moderate Acute Biliary Pancreatitis

Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis.

We have routinely performed emergent laparoscopic cholecystectomy (LC) as soon as we diagnosed acute cholecystitis (AC), if patients could tolerate surgery. This study was conducted to identify the preoperative risk factors that predict the technical difficulty of emergent LC for AC. A retrospective review of patients with AC who underwent emergent LC between 2012 and 2019 was conducted. Technical difficulty was defined as the presence of the following conditions: open conversion, operative time ≥120 min, or blood loss ≥500 ml. In all, 327 patients were included and divided into difficult LC (DLC, n=61) and nondifficult LC (non-DLC, n=266). Multivariate logistic analysis revealed that symptom duration ≥72 h was the only independent risk factor for DLC. Comparison of late LC (beyond 72 h, LLC) and early LC (within 72 h, ELC) showed a lower rate of creation of the critical view of safety and a longer hospital stay, as well as a longer operative time, a larger amount of bleeding, and a higher open conversion rate in LLC. However, the postoperative complication rates were equivalent. LC for AC with symptom duration ≥72 h tends to be technically difficult. However, it is acceptable regarding operative outcomes.

Comparative Analysis of Early versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreaticography in Cases of Cholelithiasis with Choledocholithiasis.

IntroductionA preferred treatment for cholelithiasis with choledocholithiasis is endoscopic retrograde cholangiopancreaticography (ERCP) followed by laparoscopic cholecystectomy (LC), which can be performed early (within 72 hours) or can be delayed for 6 to 8 weeks. This study is conducted to compare and analyze the outcome of early versus late LC following common bile duct (CBD) clearance by ERCP and determine the optimum timing for performing LC post-ERCP.Materials and methodsThis comparative analysis was conducted at St Joseph Hospital, Ghaziabad, from September 2019 to March 2021 on 89 cases of cholelithiasis with choledocholithiasis. Patients were divided into two groups. Group I (n = 45) patients underwent early LC within 72 hours post-ERCP and group II (n = 44) patients underwent late LC after an interval of 8 weeks. Various preoperative, perioperative, and postoperative clinical parameters like operative difficulty, complications, surgery duration, hospital stay, and conversion to open cholecystectomy were analyzed.ResultsThere was no significant difference in demographic and laboratory findings in both groups. Group I patients had significantly shorter hospital stay and less operative difficulty. The duration of surgery was significantly low in group I. There was no significant difference in rate of conversion to open cholecystectomy.ConclusionEarly LC post-ERCP is associated with short hospital stay and duration of surgery and less operative difficulty and complications. Therefore, we recommend that LC can be safely performed within 48 to 72 hours after ERCP.How to cite this articleGoel A, Kothari S, Bansal R. Comparative Analysis of Early versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreaticography in Cases of Cholelithiasis with Choledocholithiasis. Euroasian J Hepato-Gastroenterol 2021;11(1):11–13.

Early vs late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature.

BACKGROUNDGallstone pancreatitis is one of the most common causes of acute pancreatitis. Cholecystectomy remains the definitive treatment of choice to prevent recurrence. The rate of early cholecystectomies during index admission remains low due to perceived increased risk of complications. AIMTo compare outcomes including length of stay, duration of surgery, biliary complications, conversion to open cholecystectomy, intra-operative, and post-operative complications between patients who undergo cholecystectomy during index admission as compared to those who undergo cholecystectomy thereafter. METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). RESULTSInitial search identified 163 reference articles, of which 45 were selected and reviewed. Eighteen studies (n = 2651) that met the inclusion criteria were included in this analysis. Median age of patients in the late group was 43.8 years while that in the early group was 43.6. Pooled analysis showed late laparoscopic cholecystectomy group was associated with an increased length of stay by 88.96 h (95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled risk difference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group. Pooled analysis showed no risk difference in intraoperative complications [risk difference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [risk difference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy [risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and late cholecystectomy groups. Pooled analysis showed the duration of surgery to be prolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy group as compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorter hospital stay, shorter duration of surgery, while decreasing the risk of biliary complications. Rate of intraoperative, post-operative complications and chances of conversion to open cholecystectomy do not significantly differ whether cholecystectomy was performed early or late.

Early Versus Late Laparoscopic Cholecystectomy in Patients with Acute Gallstone Pancreatitis

The laparoscopic cholecystectomy is the definite treatment of acute gallstone pancreatitis, but the timing remains controversial. We aimed to evaluate trends, prevalence, and outcomes of laparoscopic cholecystectomy amongst patients with acute gallstone pancreatitis in index hospitalization done at different time intervals. We performed a retrospective study using Nationwide Inpatient Sample (years 2003–2014) with adult hospitalizations with acute gallstone pancreatitis who underwent laparoscopic cholecystectomy using ICD-9-CM codes and divided them into subgroups of those who underwent immediately (72 h), early (1 week), and delayed (> 1 week) laparoscopic cholecystectomy. The weighted analysis using chi-square, paired Wilcoxon-rank-sum test, Cochran-Armitage trend test, and multivariable survey logistic regression analysis was performed to evaluate prevalence and outcomes. There was a total of 582,406 acute gallstone pancreatitis admissions of which 291,701 (50.09%) patients had laparoscopic cholecystectomy (p < 0.0001). Prevalence of immediate laparoscopic cholecystectomy 114,629 (40.55%) showed incremental trend (32.61 to 49.82%) compared to early 149,931 (53.03%) (57.83 to 46.59%), and late laparoscopic cholecystectomy 18,158 (6.42%) (9.56 to 3.59%) from 2003 to 2014. Immediate and early laparoscopic cholecystectomy had lower prevalence and odds of mortality [0.24% versus 0.37% versus 2.46%; aOR-immediate: 0.614; aOR-early: 0.615; p < 0.0001], morbidity [1.36% versus 3.64% versus 27.57%; aOR-immediate: 0.088; aOR-early:0.161; p < 0.0001], disability [62.47% versus 70.15% versus 84.26%; aOR-immediate: 0.584; aOR-early: 0.68; p < 0.0001], discharge to non-home [7.07% versus 13.04% versus 31.84%; %; aOR-immediate: 0.346; aOR-early: 0.473; p < 0.0001], hospital cost $39,466 versus $52,018 versus $129,317 (p < 0.0001) and stay 3 days versus 6 days versus 19 days (p < 0.0001) than delayed laparoscopic cholecystectomy. The immediate laparoscopic cholecystectomy showed better outcomes; more prospective studies with large numbers of patients should be planned to evaluate the beneficial effects of immediate cholecystectomy in severe acute pancreatitis hospitalizations.

Comparative Study between Early and Late Laparoscopic Cholecystectomy in the Treatment of Acute Cholecystitis

Comparative Study between Early and Late Laparoscopic Cholecystectomy in the Treatment of Acute Cholecystitis

Early versus late laparoscopic cholecystectomy in the management of acute cholecystitis: a retrospective study

Background: Early laparoscopic cholecystectomy (LC) is a life-saving procedure in the management of acute cholecystitis as it helps in prevention of late complications like development of adhesions, haemorrhage and sepsis. The study aims at comparing the outcomes of early versus late laparoscopic cholecystectomy in the management of acute cholecystitis.Methods: A retrospective study was done by analyzing the past 5 years medical records of 250 patients admitted to the emergency department with diagnosis of acute cholecystitis established according to the Tokyo criteria. The relevant clinio-social demographic data of the patients, clinical and radiological parameters, intra-operative and post-operative findings and follow-up data were compared between early and late LC group of patients.Results: The study included 125 middle aged patients who underwent early LC (within 24 hours) and 125 patients who underwent late LC (after 24 4hours). The complication rate, conversion to open cholecystectomy and duration of surgery showed no significant differences between early and late laparoscopic cholecystectomy except for an increased duration of stay among the late LC group.Conclusions: Early LC is an efficient procedure for acute cholecystitis but it has risks of complications which can be minimized by careful selection of patients after clear clinical and radiological evaluation.

Timing of Cholecystectomy after Emergent Endoscopic Retrograde Cholangiopancreatography for Cholangitis

Debate remains regarding the timing of laparoscopic cholecystectomy after emergent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis. We hypothesized that patients undergoing early laparoscopic cholecystectomy would have fewer operative complications and a lower conversion rate. This study is a retrospective review of an ERCP database from 2012 to 2016 of adults with a diagnosis of cholangitis secondary to choledocholithiasis who underwent ERCP followed by a laparoscopic cholecystectomy. Patient demographics, ERCP details, timing of operation (<72 hours vs >72 hours after ERCP), complications, and mortality were recorded. Analysis included chi-square, Fisher's exact, and Wilcoxon rank-sum tests, where appropriate. In the 127 patients (65 per cent male; median age, 67 years; 48 (38%) early surgery), there were no differences in demographics, BMI, vital signs, or laboratory values. Patients in the late surgery group were more likely to have a Charlson Comorbidity Index > 3 (P = 0.002), require pre-operative endoscopic sphincterotomy (P < 0.002), need pre-operative insertion of a ductal stent (P < 0.03), and had more postoperative complications (P = 0.04). Patients in the late laparoscopic cholecystectomy group had more comorbidities and suffered more complications.

Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery

In this retrospective study, we aimed to assess the reliability of early cholecystectomy, risk of recurrent biliary pancreatitis, and their effects on hospital length of stay and morbidity by comparing the results of early and late laparoscopic cholecystectomy in patients with acute biliary pancreatitis. A total of 131 patients, who were diagnosed with acute biliary pancreatitis at Okmeydanı Education and Research Hospital in January 2009-December 2012, were included in the study. Demographic specifications of patients, duration of their complaints, biochemistry and hemogram values at first arrival, Ranson criteria, number of attacks, screenings, operation type and period, number of days between the first attack and operation, hospital length of stay, and complications were recorded. Patients who underwent cholecystectomy within the first 2 weeks were considered early (group 1) and those who under the operation after 2 weeks were considered late (group 2). There were 47 patients in group 1 and 84 patients in group 2. Open surgery was not performed on any patient, and there was no choledoch injury and mortality. The average hospital length of stay was 7.6±3.0 days in group 1 and 10.7±8.3 days in group 2, with a statistically significant difference between the groups (p=0.006). Two or more number of attacks occurred in 15 patients in group 2 (18%), with a statistically significant difference between the groups (p=0.000). Laparoscopic cholecystectomy is safe as it does not increase operation time and morbidity in biliary pancreatitis with a Ranson score of ≤3 or cause difficulty in dissection. Late cholecystectomy causes recurrent attacks and increases the hospital length of stay and treatment costs. Using randomized controlled studies, the effectiveness and reliability of early cholecystectomy in mild and moderate biliary pancreatitis can be verified.

Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72h of symptom onset.

Laparoscopic cholecystectomy (LC) performed for acute cholecystitis (AC) is usually advised within 72h of symptom onset. This study aimed to evaluate the outcomes of LC beyond 72h after presentation. A total of 94 patients underwent LC for AC between January 2012 and February 2015: 70 underwent early LC (ELC, operation within 72h of symptom onset) and 24 underwent late LC (LLC, beyond 72h). The outcomes of the groups were compared. Preoperative C-reactive protein (CRP) levels were significantly higher in the LLC group [9.81 (0.41-38.00) mg/dL] compared to the ELC group [1.05 (0.05-24.20) mg/dL; P=0.001]. Between-group differences were also observed in operative time, blood loss, and postoperative hospital stay [ELC, 76 (37-141) minutes, 10 (1-650) ml and 4 (3-12) days; LLC, 89 (48-234) minutes, 40 (1-3500) ml, and 6 (4-35) days; P=0.048, 0.007, and<0.001]. The conversion rate of laparoscopic to open cholecystectomy was significantly higher in the LLC group (17%) than the ELC group (1%; P=0.014). Univariate analysis identified LLC, CRP≥10mg/dL, and failure to create a critical view of safety as risk factors for conversion to open surgery, while operative time≥90min and blood loss≥100ml were risk factors for complications. LLC is associated with longer operation times, greater blood loss, longer hospital stays and higher conversion rates than ELC. Using a high CRP value as a criterion for selecting a surgical procedure, whether open or laparoscopic, would decrease the conversion rate of LLC, which may reduce operation times and blood loss.

Late two-stage laparoscopic cholecystectomy is associated with an increased risk of major bile duct injury.

Late laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (ES) for common bile duct (CBD) stone clearance, two-stage LC (TSLC), is associated with difficult surgical dissection and an increased rate of conversion to open procedure. The purpose of the study was to evaluate whether the interval between ERCP/ES and LC is associated with major bile duct injury (BDI) and determine an optimal period for TSLC. This was a retrospective cohort study of adult patients who underwent LC. The exclusion criteria were absence of CBD stones on imaging or ERCP, surgical treatment of choledocholithiasis, post-operative endoscopic CBD stone clearance and open cholecystectomy. The eligibility criteria were met by 183 patients. There were six major BDIs (3%). Comparisons of the early and late TSLC showed statistically significant difference in major BDI at 16-week cut-offs. Binomial regression analysis demonstrated that late (≥16 weeks) TSLC was associated with 10-fold increase in major BDI (95% confidence interval: 1.1-95.7, P = 0.043). Survival analysis comparing early (<16 weeks) with late (≥16 weeks) TSLC demonstrated that both groups had similar survival time (log-rank test: 0.317). General surgeons should be aware of the increasing risk of major BDI with delaying TSLC and perform interval LC before week 16.

Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis

Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% of these adults become symptomatic in a year (the majority due to biliary colic but a significant proportion due to acute cholecystitis). Laparoscopic cholecystectomy for acute cholecystitis is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and of need for conversion from laparoscopic to open cholecystectomy. However, delaying surgery exposes the people to gallstone-related complications. The aim of this systematic review was to compare early laparoscopic cholecystectomy (less than seven days of clinical presentation with acute cholecystitis) versus delayed laparoscopic cholecystectomy (more than six weeks after index admission with acute cholecystitis) with regards to benefits and harms. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and World Health Organization International Clinical Trials Registry Platform until July 2012. We included all randomised clinical trials comparing early versus delayed laparoscopic cholecystectomy in participants with acute cholecystitis. We used standard methodological procedures expected by The Cochrane Collaboration. We identified seven trials that met the inclusion criteria. Out of these, six trials provided data for the meta-analyses. A total of 488 participants with acute cholecystitis and fit to undergo laparoscopic cholecystectomy were randomised to early laparoscopic cholecystectomy (ELC) (244 people) and delayed laparoscopic cholecystectomy (DLC) (244 people) in the six trials. Blinding was not performed in any of the trials and so all the trials were at high risk of bias. Other than blinding, three of the six trials were at low risk of bias in the other domains such as sequence generation, allocation concealment, incomplete outcome data, and selective outcome reporting. The proportion of females ranged between 43.3% and 80% in the trials that provided this information. The average age of participants ranged between 40 years and 60 years. There was no mortality in any of the participants in five trials that reported mortality. There was no significant difference in the proportion of people who developed bile duct injury in the two groups (ELC 1/219 (adjusted proportion 0.4%) versus DLC 2/219 (0.9%); Peto OR 0.49; 95% CI 0.05 to 4.72 (5 trials)). There was no significant difference between the two groups (ELC 14/219 (adjusted proportion 6.5%) versus DLC 11/219 (5.0%); RR 1.29; 95% CI 0.61 to 2.72 (5 trials)) in terms of other serious complications. None of the trials reported quality of life from the time of randomisation. There was no significant difference between the two groups in the proportion of people who required conversion to open cholecystectomy (ELC 49/244 (adjusted proportion 19.7%) versus DLC 54/244 (22.1%); RR 0.89; 95% CI 0.63 to 1.25 (6 trials)). The total hospital stay was shorter in the early group than the delayed group by four days (MD -4.12 days; 95% CI -5.22 to -3.03 (4 trials; 373 people)). There was no significant difference in the operating time between the two groups (MD -1.22 minutes; 95% CI -3.07 to 0.64 (6 trials; 488 people)). Only one trial reported return to work. The people belonging to the ELC group returned to work earlier than the DLC group (MD -11.00 days; 95% CI -19.61 to -2.39 (1 trial; 36 people)). Four trials did not report any gallstone-related morbidity during the waiting period. One trial reported five gallstone-related morbidities (cholangitis: two; biliary colic not requiring urgent operation: one; acute cholecystitis not requiring urgent operation: two). There were no reports of pancreatitis during the waiting time. Gallstone-related morbidity was not reported in the remaining trials. Forty (18.3%) of the people belonging to the delayed group had either non-resolution of symptoms or recurrence of symptoms before their planned operation and had to undergo emergency laparoscopic cholecystectomy in five trials. The proportion with conversion to open cholecystectomy was 45% (18/40) in this group of people. We found no significant difference between early and late laparoscopic cholecystectomy on our primary outcomes. However, trials with high risk of bias indicate that early laparoscopic cholecystectomy during acute cholecystitis seems safe and may shorten the total hospital stay. The majority of the important outcomes occurred rarely, and hence the confidence intervals are wide. It is unlikely that future randomised clinical trials will be powered to measure differences in bile duct injury and other serious complications since this might involve performing a trial of more than 50,000 people, but several smaller randomised trials may answer the questions through meta-analyses.

Comparison of Laparoscopic Cholecystectomy for Acute Cholecystitis within and Beyond 72 h of Symptom Onset During Emergency Admissions

Laparoscopic cholecystectomy (LC) performed for acute cholecystitis (AC) is usually advised within 72 h of symptom onset. It can be difficult to accommodate all these patients within 72 h. LC beyond this early phase potentially increases the chances of LC-related complications. The aim of this study was to evaluate the outcomes of LC both within and beyond 72 h of presentation during the emergency admission. A retrospective clinical study was performed from February 2004 to December 2009. A total of 133 patients underwent LC for AC during the emergency admission according to the protocol: 34 patients underwent early LC (ELC) (i.e., operation within 72 h of symptom onset) and 99 underwent late LC (LLC) (i.e., operation beyond 72 h of symptom onset). Pathologic type of cholecystitis, duration of the procedure, conversion rate, complications, length of hospital stay (LOS), and total charges were compared between the two groups. Patients undergoing ELC experienced a significantly shorter operating time (44.1 ± 5.32 vs. 66.4 ± 3.05 min, p < 0.01). Most of the AC (95/133, 71 %) was pathologically simple cholecystitis. There was no significant difference regarding wound infection rates [1/34 (2.94 %) vs. 2/99 (2.02 %), p > 0.05] or postoperative hospital stay (6.50 ± 1.31 vs. 6.67 ± 0.73, p > 0.05) between groups. There were no conversions to open cholecystectomy, no biliary tract injury or biliary leak, no other complications, and no 30-day readmission rates in either group. ELC was less costly than LLC (6,692 ± 794 vs. 8,378 ± 802 RMB, p < 0.05). Both ELC and LLC are safe for treating of AC, but the operative difficulty of LLC is greater. ELC is superior to LLC as it tends to shorten the total LOS and is less expensive.

Synchronous pyogenic liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy)

The treatment of synchronous pyogenic liver abscess (PLA) and acute cholecystitis (AC) may be challenging. Moreover, because of the similarity of symptoms and the suboptimal accuracy of ultrasound (US), PLA(s) may be undetected, unless a computer tomography (CT) scan is performed. The aims of this study were (1) to evaluate the results of emergency cholecystostomy (CS) and late laparoscopic cholecystectomy (LC) in such a population and (2) to identify the criteria for selecting patients with AC and a high risk of having synchronous PLA(s) for referral for a CT scan. A retrospective analysis of the outcome of 12 patients with AC and PLA(s) treated by emergency CS followed by delayed LC from January 1996 through May 2010 at a tertiary-care university hospital was performed. Clinical, laboratory, and radiological data of patients with synchronous AC and PLA(s) are compared with those of 66 patients with "simple" AC. The association of age >55years, temperature >38°C, WBC count >12,000/ml, and ASAT >50 UI/l and/or ALAT >75 UI/l allows for the selection of patients at high risk of PLA to undergo a CT scan (sensitivity: 100%; specificity: 86%). All treated patients had a sudden improvement within 24h following CS. PLA was treated in 10/12 patients (83%). Hospital stay lasted 21.5±3.5days. Ten patients underwent elective LC 12±4weeks after CS with no conversion and 30% perioperative morbidity. Operating time was 91min. Hospital stay was 1.7days [7 patients (70%) underwent surgery as an outpatient]. A simple algorithm is presented for the selection of patients with AC to undergo a CT scan to identify synchronous PLA. Emergency CS followed by delayed LC is a viable, first-line treatment option for synchronous PLA and AC.

The outcome of early laparoscopic cholecystectomy in patients with acute biliary pancreatitis

Objectives: It is still controversial to perform a laparoscopic cholecystectomy (LC) for the management of acute biliary pancreatitis (ABP) at the early hospitalization period, because of adhesions and dissection difficulties. The aim of this study was to evaluate the outcome of the patients with ABP who underwent LC prior to hospital discharge. Methods: A total of 43 patients with ABP, that underwent LC after clinical and laboratory improvement, were retrospectively evaluated.Patient’s age, gender, laboratory findings; ultrasonography (USG), magnetic resonance and other imaging results, surgical operation duration, complications, mortality and postoperative hospital stay days were recorded and statistically analyzed. Results: The median age of patients was 51.8 (20-83) years. A total of 29 (67.4%) patients were women and 14 (32.6%) were male. The cause was gallstone in all patients. In addition, hyperparathyroidism was found in one patient and hyperlipidemia was present in the other one. Gallbladder stones were determined in all patients. Common bile duct enlargement and stones were detected in 7 patients. Three patients underwent sphyncterectomy and stone extraction according to clinical status. Operations were performed at the mean hospitalization day of 11.4 (3-23). LC was performed to 39 (%90.6) of patients. However, 4 (9.4%) patients had intra-abdominal adhesions secondary to infection and were switched to open surgery. The mean operation time was 70 (25-160) minutes and the mean duration of postoperative hospital stay was 3 (1-6) days. In a patient who underwent LC and ERCP preoperatively complication occurred. A second drainage operation was performed and due to development of necrotizing pancreatitis, the patient was lost at the postoperative 7th day secondary to adult type respiratory distress syndrome. Conclusions: In patients with ABP whose clinical and laboratory findings were improved, late LC can be performed safely during their first hospitalization.