Timing of laparoscopic cholecystectomy for mild and moderate acute cholecystitis.
Hepatogastroenterology. 2014 Sep;61(134):1489-93
Authors: Yoh T, Okamura R, Nobuto Y, Wada S, Nakamura Y, Kato T, Nakayama H
BACKGROUND/AIMS: The timing of a laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) remains controversial. Traditionally, LC for AC is performed within 3 days. We designed this study so that the cut-off time of LC for AC was within 7 days of admission, based on severity.
METHODOLOGY: A total of 103 patients were divided into 2 groups: patients undergoing LC within 7 days of admission [early LC (ELC), n = 41] and patients undergoing LC between 8 days and 5 weeks of admission [delayed LC (DLC), n = 62]. The outcomes compared were complication rate, conversion rate, postoperative hospital days, and operation time. Statistical analyses were performed in mild, moderate and all AC cases. Results: Of all AC cases, successful LC was performed in 93 patients, and no significant difference was observed between the 2 groups. In DLC for moderate AC, percutaneous cholecystectomy (PC) with or without endoscopic nasal bile drainage (ENBD) was performed more frequently than ELC.
CONCLUSIONS: DLC had no advantage over ELC. ELC for AC is preferable in cost–effect. Even if the operation cannot be scheduled early, proper initial treatment, including percutaneous cholecystectomy with or without endoscopic nasal bile drainage for moderate AC, enables DLC a safe option.
PMID: 25436331 [PubMed - indexed for MEDLINE]