Optimal Timing Of Laparoscopic Cholecystectomy Research Articles

Early Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography Is Feasible and Safe.

Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for cholelithiasis with common bile duct stones. However, the optimal timing of LC after ERCP remains controversial. This study aimed to identify the ideal time interval between ERCP and LC. Data from patients who underwent LC after ERCP between November 2016 and August 2022 were retrieved from the electronic medical information system. The patients were categorized into early cholecystectomy (within 72 h of ERCP) and delayed cholecystectomy (after 72 h). The impact of the time interval between ERCP and LC on perioperative outcomes was analyzed. A total of 197 patients were included in the study, with 45 undergoing early cholecystectomy and 152 undergoing delayed cholecystectomy. No significant differences in the preoperative characteristics or operative morbidity were observed between the groups (p = 0.286). However, a significant correlation was found between the time interval from ERCP to LC and the total length of stay (r = -350, p < 0.001). The findings suggest that early cholecystectomy after ERCP is feasible and safe, and performing LC within the first 72 h does not adversely affect postoperative outcomes.

Optimal Timing of Laparoscopic Cholecystectomy After Conservative Therapy for Acute Cholecystitis.

According to the Tokyo Guidelines 2018, the operation for acute cholecystitis is recommended to be performed as early as possible. However, there are cases in which early surgeries cannot be performed due to complications of patients or facility conditions, resulting in elective surgery. Hence, we retrospectively analyzed elective surgery cases in this study. There were 345 patients who were underwent laparoscopic cholecystectomy (LC) at our hospital from January 2019 to December 2020 in this retrospective study. A total of 83 patients underwent LC more than 3 days after conservative treatment. The elective LC patients were divided into the Early group (4-90 days after onset, n=36) and the Delayed group [91 days or more (13 weeks or more) after onset, n=31], excluding 16 patients who underwent percutaneous transhepatic gallbladder drainage. As for operative time, there was a significant difference between the Delayed and Early groups (91.2 vs. 117 minutes, p=0.0108). And also, there was a significant difference in the postoperative hospital stay, which was significantly shorter in the Delayed group than in the Early group (3.4 vs. 5.9 days, p=0.0436). Although there were no significant differences in either conversion rates or complication rates, both of these were decreasing in the Delayed group. In particular, there were no complications in the Delayed group. When the conservative treatment for acute cholecystitis precedes and precludes urgent/early LC within 3 days, delaying LC for at least 91 days (13 weeks or more) after onset could reduce operative time and postoperative hospital stay. Moreover, there would be no complications after LC, and the rates of conversion during LC may be kept low.

The Optimal Timing of Laparoscopic Cholecystectomy in Acute Cholecystitis: A Single-Center Study.

Introduction Early laparoscopic cholecystectomy (ELC) is a treatment option for acute cholecystitis (AC). However, the timing of ELC is controversial. Delayed laparoscopic cholecystectomy (DLC) continues to be a common practice. This study aims to determine the optimal timing of ELC in AC. Materials and methods Patients who underwent surgery for AC between 2014 and 2020 were divided into three groups: immediate laparoscopic cholecystectomy (ILC), prolonged ELC (pELC), and DLC. The demographic, laboratory, radiological findings, and postoperative results of all patients were retrospectively reviewed. Results The study included 178 patients, with 63 in the ILC group, 27 in the pELC group, and 88 in the DLC group. Postoperative outcomes, excluding hospital stay, were similar between the groups. The total hospital stay was significantly longer in the pELC and DLC groups (p<0.05). In addition, postoperative hospital stay was longer in the pELC group (p<0.05), and 17.7% of the patients who waited for delayed surgery experienced recurrent attacks during the interval period. Conclusion ILC is recommended in AC to minimize hospital stays.

TU8.3 The optimal timing of Laparoscopic cholecystectomy following percutaneous cholecystostomy in Acute cholecystitis

Abstract Introduction Percutaneous cholecystostomy (PC) is an effective option for high risk and/or delayed presented Acute cholecystitis (AC). However, the optimal timing for subsequent laparoscopic cholecystectomy (LC) as a definitive treatment remains controversial. Methods This study includes 41 patients underwent LC following PC for severe AC. We compared the length of tube insertion, period from PC till LC and period from PC removal till LC against co-morbidities, another attack of AC, subsequent pancreatitis/jaundice and operative difficulties in terms of intraoperative adhesions, drain insertion, conversion to open, length of operation. Results The median time of length of tube insertion was 36 days (range 5–208) while the median time of PC insertion till LC was 144 days (range 31–744) and for period from PC removal till LC was 78 days (range 0–714). Patients with prolonged tube insertion (more than a month) showed higher risk of developing subsequent pancreatitis and or jaundice (P=0.04) while intraoperative adhesions was associated with prolonged time from tube insertion till operation (more than 4 months). There was no significant association between neither the length of tube insertion, period from PC insertion till LC nor period from PC removal till LC and other studied parameters. Conclusion Prolonged time of PC insertion and/or prolonged time form PC insertion till LC in patients with AC have higher risk of pancreatitis and surgical difficulties. Further studies including larger number of patients’ sample is warranted to confirm the outcomes and determine the optimal time of LC following PC in those patients.

WE2.4 Optimal timing of Laparoscopic Cholecystectomy for symptomatic gallstone disease: the importance of symptom duration

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&amp;lt;0.01) in patients of group B compared to A. A similar decline was noted in surgery length(p&amp;lt;0.01) and incidence of complicated gallbladder disease (characterised by adhesions, empyema, retrograde dissection, perforation, necrosis, pancreatitis) (p&amp;lt;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&amp;lt;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.

P-BN61 Optimal timing of laparoscopic cholecystectomy for admitted acute cholecystitis patients

Abstract Background The Tokyo 2018 guidelines support emergency laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) over delayed laparoscopic cholecystectomy (DLC) for mild cholecystitis, substantiated by a lower total length of stay. The supporting studies are limited by small sample sizes, and clinically relevant findings may have been missed. The aims of the present paper were firstly, to compare the peri- and post-operative course following emergency and delayed LC for AC. Methods All patients who underwent ELC and DLC for AC following hospital admission between January 2015 and December 2019 were included in the study. Pre-operative, operative and post-operative data over a 100-day follow-up period were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were splint into groups based on previous admissions and outcomes were compared between ELC and DLC. Multivariate logistic regression models were then used on the entire cohort to adjust for other variables and to determine the impact of ELC versus DLC. Complications of the category Clavien-Dindo ≥2 were considered. Results In the group with no previous admissions (n = 630), DCL patients had lower rates of intra-/post-operative complications (8.0%vs.17.9%;p&amp;lt;0.001), lower rates of re-admission (6.6%vs.12.2%;p=0.04) and longer total length of stay (6dvs.5d;p=0.03). In patients with previous admissions (n = 181), DCL had lower rates of intra-/post-operative complications (14.1%vs.25.5%;p=0.06) but there was no significant difference in length of stay (13dvs.12d;p=0.81). The ELC group had a significantly lower admission CRP, ASA and age (p &amp;lt; 0.001). In the multivariate logistic regression models, ELC was positively associated with subtotal/conversion to open (OR,1.94;p=0.01), drain insertion (OR,2.54;p&amp;lt;0.001), bile leak (OR,2.38;p&amp;lt;0.001), post-operative imaging (OR,1.83;p=0.01), longer post-operative stay (OR,7.26,p&amp;lt;0.001) and readmission (OR-1.9;p=0.01). Conclusions DLC, once the period of active inflammation has settled, offers superior post-operative outcomes, including lower rates of complication, re-admission and post-operative length of stay; however is associated with longer total length of stay. DLC is only advised where the risk of re-admission is minimised (i.e surgery six weeks following the episode) and relies on the management of surgical waiting lists.

Clinical Impact of Preoperative Relief of Jaundice Following Endoscopic Retrograde Cholangiopancreatography on Determining Optimal Timing of Laparoscopic Cholecystectomy in Patients with Cholangitis.

Background: About 10% of patients with gallbladder (GB) stones also have concurrent common bile duct (CBD) stones. Laparoscopic cholecystectomy (LC) after removal of CBD stones using endoscopic retrograde cholangiopancreatography (ERCP) is the most widely used method for treating coexisting gallbladder and common bile duct stones. We evaluated the optimal timing of LC after ERCP according to clinical factors, focusing on preoperative relief of jaundice. Methods: A total of 281 patients who underwent elective LC after ERCP because of choledocholithiasis and cholecystolithiasis from January 2010 to April 2018 were retrospectively reviewed. We compared the hospital stay, perioperative morbidity, and rate of surgical conversion to open cholecystectomy according to the relief of jaundice before surgery. These enrolled patients were divided into two groups: relief of jaundice before surgery (group 1, n = 125) or not (group 2, n = 156). Results: The initial total bilirubin level was higher in group 1; however, there were no significant differences in the other baseline characteristics including age, sex, American Society of Anesthesiologists score, previous surgical history, white blood cell count, C-reactive protein, and operative time between the two groups. There was also no significant difference in postoperative hospital stay between the two groups (4.5 ± 3.3 vs. 5.5 ± 5.6 days, p = 0.087). However, after ERCP, the waiting time until LC was significantly longer in group 1 (5.0 ± 4.9 vs. 3.5 ± 2.4 days, p < 0.001). There were no statistical differences in the conversion rate (3.2% vs. 3.8%, p = 0.518) or perioperative morbidity (4.0% vs. 5.8%, p = 0.348), either. Conclusions: LC would not be delayed until the relief of jaundice after ERCP since there were no significant differences in perioperative morbidity or surgical conversion rate to open cholecystectomy. Early LC after ERCP may be feasible and safe in patients with cholangitis and cholecystolithiasis.

Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis

There is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis (AC). We retrospectively evaluated patients who underwent LC after PTGBD between 1 February 2016 and 1 February 2020. We divided patients into three groups according to the interval time between PTGBD and LC as follows: Group I (within 1 week), (Group II, 1 week to 1 month), and Group III (> 1 month) and analyzed patients’ perioperative outcomes. We enrolled 100 patients in this study (Group I, n = 22; Group II, n = 30; Group III, n = 48). We found no significant difference between the groups regarding patients’ baseline characteristics and no significant difference regarding operation time and estimated blood loss (p = 0.69, p = 0.26, respectively). The incidence of conversion to open cholecystectomy was similar in the three groups (p = 0.37), and we found no significant difference regarding postoperative complications (p = 0.987). Group I had shorter total hospital stays and medical costs (p = 0.005, p < 0.001, respectively) vs Group II and Group III. Early LC within 1 week after PTGBD is safe and effective, with comparable intraoperative outcomes, postoperative complications, and conversion rates to open cholecystectomy. Furthermore, early LC could decrease postoperative length of hospital stay and medical costs.

Safety of early same-admission laparoscopic cholecystectomy for acute mild biliary pancreatitis. A retrospective study for acute pancreatitis.

IntroductionAs the standard procedure for the surgical treatment for gallbladder stones, we investigated the controversy surrounding the optimal time for laparoscopic cholecystectomy (LC) for acute mild biliary pancreatitis (AMBP).AimTo further address the optimal timing of LC, we conducted a retrospective study comparing early (< 72 h, group I) with delayed (> 72 h, group II) LC for AMBP during the same admission.Material and methodsThis retrospective study included medical records of all patients who were admitted with a diagnosis of acute mild biliary pancreatitis at Dongyang People’s Hospital from July 2011 to June 2019.ResultsA total of 119 patients were divided into an early LC group (group I; 52 patients) and a control group (group II; 67 patients). Conversion to open cholecystectomy (COC) was performed in 17 patients (6 patients in group I and 11 patients in group II, p = 0.62). There were no significant differences in terms of estimated blood loss and duration of surgery (p = 0.08 and p = 0.64, respectively). The overall hospital stay in group I was significantly shorter than in group II (10.86 ±3.21 vs. 13.29 ±4.51 days, p = 0.001). Compared with postoperative bile leakage (p = 0.72) and postoperative morbidity (p = 0.97) and mortality, there were no significant differences between the groups.ConclusionsEarly LC during the same admission is safe for acute mild biliary pancreatitis and has the advantage of shortening overall hospital stay. There was no significant increase in COC, bile duct injury, and complications.

Optimal timing of laparoscopic cholecystectomy after gallbladder drainage for acute cholecystitis: A multi-institutional retrospective study.

There is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after gallbladder drainage for acute cholecystitis (AC). To obtain evidence for a consensus, we investigated surgical outcomes of LC after gallbladder drainage with respect to the time elapsed from gallbladder drainage to surgery in a multi-institutional retrospective study. This study enrolled 347 patients who underwent LC after gallbladder drainage for AC at 15 institutions. Surgical outcome of LC was investigated in the cases based on the interval from gallbladder drainage to surgery. The median interval from gallbladder drainage to surgery of the patients was 34days, with a mean±standard deviation of 58±99days. Patients were divided into four groups based on quartiles of the interval: Group A, cases with an interval of 1-12days; Group B, cases with an interval of 13-34days; Group C, cases with an interval of 35-73days; and Group D, cases with an interval of ≥74days. Surgical outcomes, which were evaluated with respect to intraoperative blood loss, operation time, postoperative hospital stay, rate of intraoperative accident, conversion from laparoscopic to open surgery, and postoperative complication, were worse in Group B than in the other groups. The finding was verified by propensity score-matched analysis. Surgical outcome of LC after gallbladder drainage for AC was inferior in Group B compared with the other groups. This finding could be useful for determining the optimal timing of LC after gallbladder drainage for AC.

Laparoscopic cholecystectomy in acute cholecystitis

Background: The optimal timing of laparoscopic cholecystectomy (LC) in acute cholecystitis still remains a debate. Recent studies emphasize that LC can be done safely within the 1st week of onset of the disease process. However, not much data are available that defines the “early” period. We observed, in our institute that, patients presenting beyond 1st week with complications or unresolving symptoms. We aim to compare the outcomes of LC performed after 1st week versus interval LC. Materials and Methods: A retrospective study of 64 patients who underwent LC from November 2017 to May 2018 was carried out. The study included one group of 32 patients who underwent LC after the 1st week (Group A) and another group of 32 patients who were operated after an interval of 6 weeks (Group B). Data were collected and compared. Results: The mean duration of surgery (71.09 vs. 84.82 min, P Conclusion: LC performed even after 7 days of initial episode scores over interval LC in terms of total hospital stay, cost, morbidity and has the advantage of treating patients who would be lost to follow-up due to neglect, occupational, and financial concerns. Further studies are needed to validate our results.

The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis: A meta-analysis.

Background:The optimal timing of laparoscopic cholecystectomy (LC) in patients with mild acute gallstone pancreatitis (MAGP) is controversial. The aim of this study was to systematically evaluate and compare the safety and efficacy of early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with MAGP.Methods:A strict search was conducted of the electronic databases, including PubMed, MEDLINE Embase, the ISI Web of Science, and Cochrane Library for all relevant English literature and RevMan5.3 software for statistical analysis was used.Results:A total of 19 studies comprising 2639 patients were included. There was no significant difference in intraoperative complications [risk ratio (RR) = 1.46; 95% confidence interval (CI) = 0.88–2.41; P = .14)], postoperative complications (RR = 0.81; 95% CI = 0.58–1.14; P = .23), rate of conversion to open cholecystectomy (RR = 1.00; 95% CI = 0.75–1.33; P = .99), operative time (MD = 1.60; 95% CI = −1.36–4.56; P = .29), and rate of readmission (RR = 0.63; 95% CI = 0.19–2.10; P = .45) between the ELC and DLC groups. However, the ELC group was significantly correlated with lower length of hospital stay (MD = −2.01; 95% CI = −3.15 to −0.87; P = .0006), fewer gallstone-related events rates (RR = 0.17; 95% CI = 0.07–0.44; P = .0003), and lower endoscopic retrograde cholangiopancreatography (ERCP) usage (RR = 0.83; 95% CI = 0.71–0.97; P = .02) compared with the DLC group.Conclusion:Early laparoscopic cholecystectomy is safe and effective for patients with MAGP, but the indications and contraindications must be strictly controlled.

Evaluation of optimal time for laparoscopic cholecystectomy following acute cholecystitis attack in a tertiary care health centre

Background: At the present time, acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy but when to perform surgery still remains controversial. The aim of present study is to find out if laparoscopic cholecystectomy can be carried out for acute cholecystitis irrespective of the time since onset of acute symptoms. Methods: We conducted a short term 6 months retrospective analysis of 24 patients in our hospital who underwent eTEP procedure for umbilical hernia and inguinal hernia, with a minimum of 3 months follow-up. Their data were analyzed for operative details, intra‑operative and post‑operative complications. Results: Judging from our short term results, for 24 patients we have not come across any post-operative complications like seroma, SSI, recurrence, with a minimum of 3 months follow-up. Conclusion:Laparoscopic cholecystectomy can be performed anytime of presentation of acute cholecystitis. Although delaying laparoscopic cholecystectomy was associated with more complications, higher mortality, and higher costs.

Early laparoscopic cholecystectomy in acute cholecystitis: Preferable option

Background: Approximately 80% of the cholecystectomies are performed laparoscopically. Traditionally, acute cholecystitis is treated conservatively followed by delayed cholecystectomy 6-8 weeks after the acute attack. Various studies have addressed the optimal timing of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. The aim of this study was to compare early and delayed laparoscopic cholecystectomy. Methods: A retrospective study was conducted in 60 patients presenting with acute cholecystitis to compare early and delayed laparoscopic cholecystectomy, focussing on intra-operative and postoperative parameters like duration of surgery, surgical difficulties and complications, analgesic requirement, duration of postoperative hospital stay and wound related complications.Results: Longer operation times were required in the early group. Postoperative pain scores and analgesic requirements were almost similar in two groups. The cost of treatment in the delayed group was significantly higher.Conclusion: Though early laparoscopic cholecystectomy required longer operative times, it resulted in reduced the cost of treatment than delayed LC. Conclusion: Though early laparoscopic cholecystectomy required longer operative times, it resulted in reduced the cost of treatment than delayed LC.

RESULTS OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH AN ACUTE CALCULUS CHOLECYSTITIS AND ISCHEMIC HEART DISEASE

Relevance. Determination of the optimal time for laparoscopic cholecystectomy (LCE) in patients with acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) is still an actual and unresolved issue.&#x0D; Objective: to evaluate the results early versus delayed LCE in patients with ACC and IHD.&#x0D; Materials and methods. The study involved 107 patients with ACC and IHD: 56 (47,7 %) women and 51 (52,3 %) men aged 55 to 82 years, an average 70,2±0,6 years. The group with early LCE (ELCE) included 48 patients with LCE – up to 72 hours from the beginning of ACC (on average 41,9±2,1 hours), the group with delayed LCE (DLCE) – 59 patients, who were LCE for more than 72 hours (in average 90,2±1,6 hours) from the beginning of ACC. Groups of patients were representative according to the functional classes of heart failure, angina pectoris, severity and the histological form of ACC. All patients had a Charlson comorbidity index from 0 to 2 points. The endpoint of the study were: the frequency of conversion to open cholecystectomy, cardiac events in the intra – and early postoperative periods, the incidence of complications according to the Clavien-Dindo classification. Data analysis was performed using IBM SPSS Statistics.&#x0D; Results. The duration of LCE in the DLCE group was 45,2±2,1 minutes, in the ELCE group it was 40,9±1,4 min (p=0,115). Conversion to open cholecystectomy was required in 8 (13,6 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0,033. During the operation, myocardial ischemia occurred in 17 (28,8 %) patients of the DLCE group versus 6 (12,5%) the ELCE group, p=0,041, and a systolic blood pressure decrement lower than 70 mm hg. art. – in 24 (40,7 %) against 8 (16,7 %), p=0,007; saturation reduction episodes – in 33 (55,9 %) against 17 (35,4 %), p=0,034, respectively. In the early postoperative period, an increasing of HF class according to NYHA was observed in 12 (20,3 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0.004; the number of patients with complications according to Clavien-Dindo classification – 40 (67,8 %) versus 23 (47,9 %), p=0,038; pneumonia occurred in 26 (44,1 %) against 6 (12,5 %), p=0,001; exudative pleurisy – in 28 (47,5 %) against 9 (18,8 %), p=0,002, respectively. There were no lethal cases in the period up to 7 days in both groups.&#x0D; Conclusion. ELCE is a priority method of treatment patients with an acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) with a different functional class (according to NYHA). Compared with DLCE, it is associated with reliable reduce of conversion (2,1 %), against 8 (13,6 %), intra- and early postoperative complications of the cardiovascular system and complications according to Clavien-Dindo classification – 23 (47,9 %) patients against 40 (67,8 %).

Optimal timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography

Background: Nowadays in patients with cholelithiasis with choledocholithiasis, the ideal treatment is endoscopic retrograde cholangiopancreatographic (ERCP) removal of duct stone and laparoscopic cholecystectomy. But when to do and whether we can do it simultaneously or one after another and what interval should be there, that is always controversial. The purpose was an optimal gap for cholecystectomy after ERCP.Methods: We have done a comparison study in 60 patients within a duration of 2 year who had already done ERCP. Group 1, those patients who had laparoscopic cholecystectomy within 72 hours compared with group 2 who had laparoscopic cholecystectomy after an interval of 6 week. Primary outcome was the conversion rate from lap to open cholecystectomy. Secondary outcome was duration of operation, intra-operative difficulties, postoperative morbidity and hospital stay.Results: Of 60 consecutive patients 30 were in group I and 30 were in group II. There is no difference in demographics, laboratory or ultrasonographic findings. The hospital stays in group I is significantly shorter than group II and conversion rate; operative time is higher in group II. No statistically significant difference in post-operative morbidity between both groups.Conclusions: Early laparoscopic cholecystectomy within 72 hr is better than interval (6 week) cholecystectomy after ERCP with shorter hospital stay and less intraoperative difficulties.

A study to evaluate the optimal time for laparoscopic cholecystectomy after acute cholecystitis attack: a tertiary care centre study

Background: Initially, laparoscopic cholecystectomy was contraindicated in patients with acute cholecystitis because of the fear of increased morbidity and high rates (60%) of conversion to open surgery. Nowadays, acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy but when to perform surgery still remains controversial. The purpose of this study is to find out whether laparoscopic cholecystectomy can be performed for acute cholecystitis irrespective of the time since onset of acute symptoms. Methods: A total of 100 laparoscopic cholecystectomies performed for acute cholecystitis were evaluated for duration of surgery, conversion rates, biliary and other organ injury, and postoperative stay by chi square test and paired t-tests using SPSS software. 45 patients underwent laparoscopic cholecystectomy within 48 h to seven days of onset of symptoms (group 1) and 55 patients underwent surgery after 6 weeks of onset of symptoms (group 2). Results: While the duration of surgery was comparable in both groups (56.5±15 vs. 45.5±15 min), there were no significant difference in conversions or major biliary or other organ injury in any of the two groups. Postoperative stay was also comparable between the two groups (4±1.5 vs 3±1.5, days) but total hospital stay was significantly reduced in group1 compared to group 2 (5±1.5 vs 8.5±1.5 days) and so as total cost is also reduced. Conclusions: Laparoscopic cholecystectomy can safely be performed at any time after the onset of acute cholecystitis. Early laparoscopic cholecystectomy has an outcome comparable to the delayed procedure, with a shorter total hospital stay and lower total costs, and it should be considered as the preferred approach in treatment of acute cholecystitis.

Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis.

Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis. This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44). There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%; p=0.013). Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion.

Optimal Timing of Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography

Background: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) comprises the current treatment modality in patients with common bile duct (CBD) stones. The optimum interval between ERCP and LC is a topic of debate. M ethods: A total of 50 patients underwent LC following ERCP from December 2011 to October 2013. Of these, 28 patients underwent surgery within 3 days of ERCP (early) and 22 patients beyond 3 days following ERCP (delayed). A prospective observational study of various technical difficulties encountered (operative duration, adhesions, frozen C alot’s, bile duct injuries, conversion rate and need for drain) was done and comparison was done. Results: The incidence of adhesions, frozen Calot’s, cystic duct injury, need for drain placement and the mean operative duration and postoperative stay were significantly higher in the delayed group. The conversion rate though higher is not statistically significant. Conclusion: The longer the interval between ERCP and LC, the higher are the chances of encountering complications and the risk of conversion to open technique as well as the need for increased hospital stay following surgery. Early LC following ERCP is preferred. J Curr Surg. 2014;4(2):35-39 doi: http://dx.doi.org/10.14740/jcs230w

What is the optimal time for laparoscopic cholecystectomy in gallbladder empyema?

With the accumulating experience in laparoscopic surgery, early laparoscopic cholecystectomy (LC) is increasingly offered for acute cholecystitis. However, early LC without percutaneous transhepatic gallbladder drainage (PTGBD) for gallbladder empyema is still believed to be unsafe. The purpose of this study was to determine the optimal time for LC in gallbladder empyema. A retrospective analysis was carried out of patients who underwent LC without PTGBD for gallbladder empyema between August 2007 and December 2010. All cases were confirmed by biopsy. The patients were divided into two groups on the basis of a cutoff of 72h. LC for gallbladder empyema was performed without PTGBD in 61 patients during the study period. The overall conversion rate was 6.6%. Based on the 72h cutoff, there were 33 patients in the early group and 28 in the delayed group. There were no significant differences between early and late patients with respect to operation duration (75.5 vs. 71.4min, p=0.537), postoperative hospital stay (4.2 vs. 3.3days, p=0.109), conversion rate (12.1 vs. 0%, p=0.118), and complication rate (12.1 vs. 3.6%, p=0.363). However, the early group had a significantly shorter total hospital stay (5.3 vs. 8.7days, p=0.001). Early LC without PTGBD is safe and feasible for gallbladder empyema and is associated with a low conversion rate. Delayed LC for gallbladder empyema has no advantages and results in longer total hospital stays. LC should be performed as soon as possible within 72h after admission to decrease length of hospital stay.