Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1998 Apr;227(4):461–467. doi: 10.1097/00000658-199804000-00001

Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

C M Lo 1, C L Liu 1, S T Fan 1, E C Lai 1, J Wong 1
PMCID: PMC1191296  PMID: 9563529

Abstract

OBJECTIVE: A prospective randomized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates. It is not known whether there is a role for initial conservative treatment followed by interval elective operation. METHOD: During a 26-month period, 99 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n = 49) or delayed interval surgery after initial medical treatment (delayed group, n = 50). Thirteen patients (four in the early group and nine in the delayed group) were excluded because of refusal of operation (n = 6), misdiagnosis (n = 5), contraindication for surgery (n = 1), or loss to follow-up (n = 1). RESULTS: Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n = 3) and persistent fever (n = 5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs. 11%; p = 0.174) and complication rate (29% vs. 13%; p = 0.07). For 38 patients with symptoms exceeding 72 hours before admission, the conversion rate remained high after delayed surgery (30% vs. 17%; p = 0.454). In addition, delayed laparoscopic cholecystectomy prolonged the total hospital stay (11 days vs. 6 days; p < 0.001) and recuperation period (19 days vs. 12 days; p < 0.001). CONCLUSIONS: Initial conservative treatment followed by delayed interval surgery cannot reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis. Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Full text

PDF
461

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bender J. S., Zenilman M. E. Immediate laparoscopic cholecystectomy as definitive therapy for acute cholecystitis. Surg Endosc. 1995 Oct;9(10):1081–1084. doi: 10.1007/BF00188991. [DOI] [PubMed] [Google Scholar]
  2. Cox M. R., Wilson T. G., Luck A. J., Jeans P. L., Padbury R. T., Toouli J. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg. 1993 Nov;218(5):630–634. doi: 10.1097/00000658-199321850-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Eldar S., Sabo E., Nash E., Abrahamson J., Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg. 1997 Jun;21(5):540–545. doi: 10.1007/pl00012283. [DOI] [PubMed] [Google Scholar]
  4. Järvinen H. J., Hästbacka J. Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg. 1980 Apr;191(4):501–505. doi: 10.1097/00000658-198004000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Koo K. P., Thirlby R. C. Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation? Arch Surg. 1996 May;131(5):540–545. doi: 10.1001/archsurg.1996.01430170086016. [DOI] [PubMed] [Google Scholar]
  6. Kum C. K., Eypasch E., Lefering R., Paul A., Neugebauer E., Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg. 1996 Jan;20(1):43–49. doi: 10.1007/s002689900008. [DOI] [PubMed] [Google Scholar]
  7. Kum C. K., Goh P. M., Isaac J. R., Tekant Y., Ngoi S. S. Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1994 Nov;81(11):1651–1654. doi: 10.1002/bjs.1800811130. [DOI] [PubMed] [Google Scholar]
  8. Lo C. M., Fan S. T., Liu C. L., Lai E. C., Wong J. Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg. 1997 Jun;173(6):513–517. doi: 10.1016/s0002-9610(97)00005-6. [DOI] [PubMed] [Google Scholar]
  9. Lo C. M., Liu C. L., Lai E. C., Fan S. T., Wong J. Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Ann Surg. 1996 Jan;223(1):37–42. doi: 10.1097/00000658-199601000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Miller R. E., Kimmelstiel F. M. Laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 1993 Jul-Aug;7(4):296–299. doi: 10.1007/BF00725943. [DOI] [PubMed] [Google Scholar]
  11. Norrby S., Herlin P., Holmin T., Sjödahl R., Tagesson C. Early or delayed cholecystectomy in acute cholecystitis? A clinical trial. Br J Surg. 1983 Mar;70(3):163–165. doi: 10.1002/bjs.1800700309. [DOI] [PubMed] [Google Scholar]
  12. Rattner D. W., Ferguson C., Warshaw A. L. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993 Mar;217(3):233–236. doi: 10.1097/00000658-199303000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Reddick E. J., Olsen D. O. Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy. Surg Endosc. 1989;3(3):131–133. doi: 10.1007/BF00591357. [DOI] [PubMed] [Google Scholar]
  14. WRIGHT H. K., HOLDEN W. D. The risks of emergency surgery for acute cholecystitis. Arch Surg. 1960 Sep;81:341–347. doi: 10.1001/archsurg.1960.01300030001001. [DOI] [PubMed] [Google Scholar]
  15. Wiesen S. M., Unger S. W., Barkin J. S., Edelman D. S., Scott J. S., Unger H. M. Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis. Am J Gastroenterol. 1993 Mar;88(3):334–337. [PubMed] [Google Scholar]
  16. Wilson R. G., Macintyre I. M., Nixon S. J., Saunders J. H., Varma J. S., King P. M. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ. 1992 Aug 15;305(6850):394–396. doi: 10.1136/bmj.305.6850.394. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Zucker K. A., Flowers J. L., Bailey R. W., Graham S. M., Buell J., Imbembo A. L. Laparoscopic management of acute cholecystitis. Am J Surg. 1993 Apr;165(4):508–514. doi: 10.1016/s0002-9610(05)80951-1. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES