Efficacy of acute laparoscopic cholecystectomy for acute calculous cholecystitis regardless the length of symptoms

INTRODUCTION: Although early acute laparoscopic cholecystectomy within 72 hours is considered method of choice for acute calculous cholecystitis, controversy persists concerning its indication in case of prolonged symptoms.
METHODS: Prospectively run data of patients operated on for acute calculous cholecystitis over period of 3 years in tertiary referral center were analyzed. Acute surgery was performed, regardless of the duration of symptoms, provided that no prohibitive surgical factors were present. Only patients with histopathologically confirmed acute cholecystitis were included in the study. Analyzed parameters included age, gender, preoperative C-reactive protein (CRP) level, time interval from onset of symptoms until surgery, operating time, intraoperative and postoperative complications, conversion rate, length of hospital stay, readmission, and reoperation rate. Analysis was performed on intention-to-treat basis.
RESULTS: Total of 157 consecutive patients, of whom 90 were female and 67 were male, underwent acute cholecystectomy during study period. In all, 130 laparoscopic procedures were performed (83%) and there were 15 conversions (11.5%). Mean patient age was 59.15±13.33 years (range: 24-83 years), preoperative CRP was 57.04 ±80.84 mg/L (range: 0.6-455 mg/L), onset of symptoms-operation interval was 81.92±81.12 hours (range: 5-336 hours), and operating time was 84.47±35.35 minutes (range: 35-270 minutes). Ten intraoperative complications: 3 cases of bleeding from the liver bed, 5 gallbladder perforations, 1 bile duct injury, and 1 instance of arrhythmia were observed. Four postoperative complications occurred: 1 hemoperitoneum, 1 subhepatic connection, 1 transitory intestinal obstruction, and 1 port site abscess. Mean hospital stay was 6.48±4.00 days (range: 3-26 days). Although 1 reoperation was necessary, there was no readmission.
DISCUSSION AND CONCLUSION: Acute laparoscopic cholecystectomy for acute calculous cholecystitis seems to be effective when performed at experienced center regardless of duration of symptoms.