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. 1996 Jan;223(1):37–42. doi: 10.1097/00000658-199601000-00006

Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.

C M Lo 1, C L Liu 1, E C Lai 1, S T Fan 1, J Wong 1
PMCID: PMC1235061  PMID: 8554416

Abstract

OBJECTIVE: The current study compared the results of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. SUMMARY BACKGROUND DATA: Although recent reports have suggested the use of laparoscopic cholecystectomy for acute cholecystitis, the complication and conversion rates remain high. No data are available on whether initial medical treatment can improve the results. METHOD: Among 497 patients who underwent laparoscopic cholecystectomy, 52 (10.5%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. Twenty-seven of these patients had early surgery, that is, within 120 hours of admission, and 25 had interval cholecystectomy after initial medical treatment. RESULTS: The early group required modifications in operative technique more frequently (p < 0.001). The conversion rate (7.4%) and minor complication rate (22%) were comparable. Successful early laparoscopic cholecystectomy required a longer operative time (137.2 minutes vs. 98.0 minutes; p < 0.05) and postoperative hospital stay (4.6 days vs. 2.5 days; p < 0.005) but reduced the total hospital stay (6.4 days vs. 12.4 days; p < 0.001). CONCLUSIONS: Early laparoscopic cholecystectomy for the treatment of acute cholecystitis has no adverse effect on complication and conversion rates. Although it is technically demanding and time consuming, this procedure provides the economic advantage of a markedly reduced total hospital stay.

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Selected References

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  1. Bass E. B., Pitt H. A., Lillemoe K. D. Cost-effectiveness of laparoscopic cholecystectomy versus open cholecystectomy. Am J Surg. 1993 Apr;165(4):466–471. doi: 10.1016/s0002-9610(05)80942-0. [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. Fink-Bennett D., Freitas J. E., Ripley S. D., Bree R. L. The sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis. Arch Surg. 1985 Aug;120(8):904–906. doi: 10.1001/archsurg.1985.01390320028004. [DOI] [PubMed] [Google Scholar]
  4. Fried G. M., Barkun J. S., Sigman H. H., Joseph L., Clas D., Garzon J., Hinchey E. J., Meakins J. L. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994 Jan;167(1):35–41. doi: 10.1016/0002-9610(94)90051-5. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. 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]
  7. Lee V. S., Chari R. S., Cucchiaro G., Meyers W. C. Complications of laparoscopic cholecystectomy. Am J Surg. 1993 Apr;165(4):527–532. doi: 10.1016/s0002-9610(05)80955-9. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. 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]
  10. Ralls P. W., Colletti P. M., Lapin S. A., Chandrasoma P., Boswell W. D., Jr, Ngo C., Radin D. R., Halls J. M. Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs. Radiology. 1985 Jun;155(3):767–771. doi: 10.1148/radiology.155.3.3890007. [DOI] [PubMed] [Google Scholar]
  11. 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]
  12. 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]
  13. Schirmer B. D., Edge S. B., Dix J., Hyser M. J., Hanks J. B., Jones R. S. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991 Jun;213(6):665–677. doi: 10.1097/00000658-199106000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Unger S. W., Rosenbaum G., Unger H. M., Edelman D. S. A comparison of laparoscopic and open treatment of acute cholecystitis. Surg Endosc. 1993 Sep-Oct;7(5):408–411. doi: 10.1007/BF00311731. [DOI] [PubMed] [Google Scholar]
  15. Van der Linden W., Edlund G. Early versus delayed cholecystectomy: the effect of a change in management. Br J Surg. 1981 Nov;68(11):753–757. doi: 10.1002/bjs.1800681102. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. 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]
  18. 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]

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