Assessment of different timing for early laparoscopic cholecystectomy in acute calcular cholecystitis: a multicentric prospective cohort study

Mohammed, Mohammed M.; El Nakeeb, Ayman; Ezzat, Helmy; El-Magd, El-Sayed A.; Kayed, Taha; Sewefy, Alaa M.; AlMalki, Ahmad; Alqarni, Ahmed; Ghazwani, Mohammed; Alzahrani, Mohamed; Alshehri, Mohammed; Alkhathami, Awdah; Mannai, Saber; Attia, Mohamed

doi:10.4103/ejs.ejs_129_21

Assessment of different timing for early laparoscopic cholecystectomy in acute calcular cholecystitis: a multicentric prospective cohort study

Authors

Abstract

Background
The ideal timing for early laparoscopic cholecystectomy (ELC) continues to be controversial in patients with acute calcular cholecystitis (ACC). This research was constructed to identify the effects of different ELC timing in ACC on surgical outcomes in terms of safety and efficacy.
Patients and methods
This multicentric analysis involved 939 successive patients with ACC ELC. Patients were divided into three groups according to the timing of the surgery: from the onset of symptoms within the first 3 days (group 1), between 4 and 7 days (group 2), and beyond 7 days (group 3). The primary outcome was the incidence of postoperative morbidity.
Results
The median operative time, the time to reach a critical view of safety, and the time of dissection of gall bladder were significantly more in G3. The conversion rate and blood loss were significantly more in G3. No statistical difference among the three groups was observed regarding the rate of postoperative morbidity and postoperative stay. The grade of cholecystitis, cystic duct diameter greater than 5 mm, method of closure of cystic duct, and development of intraoperative complications were the independent factors of the development of postoperative complications. Age greater than 60 years, gall bladder status, grade of adhesions, cystic duct diameter greater than 5 mm, and development of intraoperative complications were the independent factors of conversion.
Conclusion
ELC was performed safely at any time after the onset of ACC. ELC beyond seven days was associated with more blood loss, increased operative time, and increased conversion rate.

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