Laparoscopic cholecystectomy for management of acute calculous cholecystitis within and after 3 days of symptom beginning: a retrospective study

Objective
The aim of this study was to evaluate the competency and safety of surgical management of acute calculous cholecystitis (ACC) through laparoscopic cholecystectomy (LC) within and after 72 h of symptom onset. We are reviewing our experience by comparing the outcomes of both ways to carry out an ideal therapeutic strategy used for ACC.
Background
ACC is a very frequent surgical insult. The timing of surgery in the management of such condition is a subject of controversy among all surgeons. In this study, we tried to share in solving this conflict to implement the optimal timing of LC for ACC.
Patients and methods
The study includes 100 patients with ACC, divided according to the timing of LC into group E (50 patients), operated within 72 h of symptom onset and group L (50 patients), operated beyond 72 h of symptom onset. Patients in both groups monitored since admission, during operations, and along the postoperative (PO) period. The data collected include demographic data, clinical data, duration of symptoms before surgery, coexisting disease, laboratory and image results, operative data, PO complications, the length of stay in ICU and the total length of hospitalization.
Results
Fever and Murphy’s sign were significantly greater in the early LC group. Initial total bilirubin and blood urea nitrogen are significantly higher (=0.032 and 0.004, respectively) among the late LC group. The operative time and mean total hospital stay are significantly higher (=0.005 and 0.010, respectively) in the late LC group compared with the early LC group. The rates of PO bile leakage and port-site infections were higher among patients of late LC group.
Conclusion
Emergent LC is a safe and reliable procedure for ACC within 72 h of symptom onset. Regarding the PO outcomes, financial costs and length of hospital stay, it is more helpful than LC beyond 72 h.