Timing of laparoscopic cholecystectomy for mild and moderate acute cholecystitis.

ABSTRACT

BACKGROUND/AIMS: The timing of a laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) remains controversial. Traditionally, LC for AC is performed within 3 days. We designed this study so that the cut-off time of LC for AC was within 7 days of admission, based on severity. METHODOLOGY: A total of 103 patients were divided into 2 groups patients undergoing LC within 7 days of admission [early LC (ELC), n = 41] and patients undergoing LC between 8 days and 5 weeks of admission [delayed LC (DLC), n = 62]. The outcomes compared were complication rate, conversion rate, postoperative hospital days, and operation time. Statistical analyses were performed in mild, moderate and all AC cases. Results: Of all AC cases, successful LC was performed in 93 patients, and no significant difference was observed between the 2 groups. In DLC for moderate AC, percutaneous cholecystectomy (PC) with or without endoscopic nasal bile drainage (ENBD) was performed more frequently than ELC. CONCLUSIONS: DLC had no advantage over ELC. ELC for AC is preferable in cost­effect. Even if the operation cannot be scheduled early, proper initial treatment, including percutaneous cholecystectomy with or without endoscopic nasal bile drainage for moderate AC, enables DLC a safe option.