Am Fam Physician. 2007;76(5):708-711
Background: Traditionally, open cholecystectomy was performed after an episode of acute cholecystitis had resolved. More recent surgical practice has favored cholecystectomy during the acute episode, and laparoscopic approaches have become more common. There have been no published studies comparing the outcomes of immediate cholecystectomy versus delayed surgery.
The Study: Stevens and colleagues studied the records of all patients who underwent laparoscopic cholecystectomy during an admission for acute cholecystitis to a university surgical unit. Patients with no evidence of cholelithiasis on imaging studies, pancreatitis, and those who had significant comorbidities were excluded from the study. Outcomes for patients who underwent surgery within 24 hours were compared with outcomes for those whose surgery was delayed longer than 24 hours.
Results: Patients in each group were similar in average age (40 years), average body mass index (30 kg per m2), history of abdominal surgery, and laboratory findings. Measured outcomes included the mean length of operation, conversion to open procedures, postoperative complications, and the patient's length of hospitalization.
The groups did not differ significantly in operative time; conversion to open surgery; or complications, some of which included common bile duct injury, bile leaks, wound infections, intra-abdominal abscess, and ileus (see accompanying table). One patient died of multiple organ failure, which was attributed to his advanced age (90 years) and multiple comorbidities. The only significant difference between the two groups of patients was an additional day of hospitalization for patients in the delayed surgery group.
|Outcome||Early surgical group (n = 132)||Delayed surgical group (n = 121)|
|Mean operating time||92 ± 41 minutes||95 ± 40 minutes|
|Conversions to open procedures||12 (9%)||7 (6%)|
|Postoperative complications||9 (7%)||11 (9%)|
|Length of hospitalization||2 days ± 1||3 days ± 2|
Conclusion: Immediate laparoscopic cholecystectomy is safe for patients with acute cholecystitis and is associated with shorter hospital stays and lower costs than delayed surgery.