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Early laparoscopic cholecystectomy for acute cholecystitis is safe regardless of timing

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Abstract

Purpose

The optimal timing for laparoscopic cholecystectomy for acute cholecystitis (AC) has not been resolved. In the revised Tokyo Guidelines from 2018 (TG18), early laparoscopic cholecystectomy (ELC) is recommended regardless of the duration of symptoms. The aim of this study was to evaluate the safety of ELC compared with delayed laparoscopic cholecystectomy (DLC) for AC. In addition, we assessed the perioperative outcomes after ELC based on duration of symptoms.

Methods

A retrospective cohort study of patients operated for acute calculous cholecystitis from January 1, 2017, to June 30, 2018, at Copenhagen University Hospital, Herlev. ELC was divided into three subgroups based on the duration of symptoms from onset to operation, ≤ 72 h, > 72–120 h, > 120 h.

Results

Two hundred twenty-two patients underwent ELC and 26 (10.5%) patients underwent DLC. We found no difference in mortality, morbidity, conversion rate, or bile duct injuries between DLC and ELC or in the subgroups based on duration of symptoms. We found significantly longer total hospital length of stay for patients with symptoms > 72 h (4.1–5.6 days) compared to ≤ 72 h (3.1 days) and the longest in DLC (9.9 days). Twenty-three percent of DLC needed an emergency operation in the waiting period with a high conversion rate (1/3).

Conclusion

ELC for AC even beyond 5 days of symptoms is safe and not associated with increased complications. The duration of symptoms in AC is not an independent predictor and should not influence the surgeonsmsdecision to perform an ELC. Delaying cholecystectomy has a high failure rate.

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Authors and Affiliations

  1. Department of Surgery, Herlev Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Nina Sonne Bundgaard, Aske Bohm, Anna Koldbro Hansted & Anders Peter Skovsen

Authors
  1. Nina Sonne Bundgaard
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  2. Aske Bohm
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  3. Anna Koldbro Hansted
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  4. Anders Peter Skovsen
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Contributions

All authors contributed to the study conception and design. Anders Peter Skovsen, Anna Hansted, and Nina Sonne Bundgaard performed data collection. Aske Bohm performed data analysis. Nina Sonne Bundgaard wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Nina Sonne Bundgaard.

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Bundgaard, N.S., Bohm, A., Hansted, A.K. et al. Early laparoscopic cholecystectomy for acute cholecystitis is safe regardless of timing. Langenbecks Arch Surg 406, 2367–2373 (2021). https://doi.org/10.1007/s00423-021-02229-2

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  • DOI: https://doi.org/10.1007/s00423-021-02229-2

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