Top

Published in:

01-12-2013 | Original Article

Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients

Authors: Luca Degrate, Arianna Libera Ciravegna, Margherita Luperto, Marcello Guaglio, Mattia Garancini, Matteo Maternini, Laura Giordano, Fabrizio Romano, Luca Gianotti, Franco Uggeri

Published in: Langenbeck's Archives of Surgery | Issue 8/2013

Abstract

Purpose

Early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute cholecystitis (AC), but the optimal surgical timing is controversial. The aim of this study was to retrospectively verify the outcome of patients with AC according to different timing of cholecystectomy.

Methods

Patients undergoing cholecystectomy for AC from 2006 to 2012 were stratified into two groups: initial admission cholecystectomy (IAC) and delayed cholecystectomy (DC, after at least 4 weeks). Among IAC, a subgroup undergoing immediate cholecystectomy (IC, within 72 h of symptom onset) was further analyzed.

Results

Three-hundred and sixteen consecutive patients were studied. IAC group included 262 patients (82.9 %) and DC group included 54 patients (17.1 %). The two groups were similar in conversion rate, operation length, and overall complication rate. The total length of hospitalization was longer in DC patients (p = 0.005). Among DC patients, 25.9 % required re-hospitalization while waiting an elective procedure. In the group undergoing IC (66 patients), conversion rate, length of operation, and postoperative morbidity were similar to that of the IAC group. Length of stay was shorter in IC group (p < 0.001). Multivariate analysis identified moderate–severe AC grading and ASA score ≥ 3 as predictors of postoperative complications.

Conclusions

The timing of cholecystectomy for AC does not seem to affect conversion rate and postoperative morbidity. Therefore the 72-h period should not be considered a strict limit to perform LC, provided that the operation is carried out during the initial hospital admission.

Duncan CB, Riall TS (2012) Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointest Surg 16(11):2011–2025PubMedCrossRef

Halldestam I, Enell EL, Kullman E, Borch K (2004) Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 91(6):734–738PubMedCrossRef

Norrby S, Herlin P, Holmin T, Sjödahl R, Tagesson C (1983) Early or delayed cholecystectomy in acute cholecystitis? A clinical trial. Br J Surg 70(3):163–165PubMedCrossRef

McArthur P, Cuschieri A, Sells RA, Shields R (1975) Controlled clinical trial comparing early with interval cholecystectomy for acute cholecystitis. Br J Surg 62(10):850–852PubMedCrossRef

Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227(4):461–467PubMedCrossRef

Skouras C, Jarral O, Deshpande R, Zografos G, Habib N, Zacharakis E (2012) Is early laparoscopic cholecystectomy for acute cholecystitis preferable to delayed surgery?: Best evidence topic (BET). Int J Surg 10(5):250–258PubMedCrossRef

Strasberg SM (2008) Clinical practice. Acute calculous cholecystitis. N Engl J Med 358(26):2804–2811PubMedCrossRef

Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S (2012) Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 26(8):2134–2164PubMedCrossRef

Lee AY, Carter JJ, Hochberg MS, Stone AM, Cohen SL, Pachter HL (2008) The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital. Am J Surg 195(4):467–470PubMedCrossRef

10.

Casillas RA, Yegiyants S, Collins JC (2008) Early laparoscopic cholecystectomy is the preferred management of acute cholecystitis. Arch Surg 143(6):533–537PubMedCrossRef

11.

Cameron IC, Chadwick C, Phillips J, Johnson AG (2004) Management of acute cholecystitis in UK hospitals: time for a change. Postgrad Med J 80(943):292–294PubMedCrossRef

12.

Senapati PS, Bhattarcharya D, Harinath G, Ammori BJ (2003) A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann R Coll Surg Engl 85(5):306–312PubMedCrossRef

13.

Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C (2007) Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 14(1):78–82PubMedCrossRef

14.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCrossRef

15.

Dàvila D, Manzanares C, Picho ML, Albors P, Cardenas F, Fuster E (1999) Experience in the treatment (early vs. delayed) of acute cholecystitis via laparoscopy. Cir Esp 66:233

16.

Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85(6):764–767PubMedCrossRef

17.

Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003) Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 7(5):642–645PubMedCrossRef

18.

Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V (2004) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 18(9):1323–1327PubMedCrossRef

19.

Serralta AS, Bueno JL, Planells MR, Rodero DR (2003) Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. Surg Laparosc Endosc Percutan Tech 13(2):71–75PubMedCrossRef

20.

Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97(2):141–150PubMedCrossRef

21.

Siddiqui T, MacDonald A, Chong PS, Jenkins JT (2008) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg 195(1):40–47PubMedCrossRef

22.

Lau H, Lo CY, Patil NG, Yuen WK (2006) Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc 20(1):82–87PubMedCrossRef

23.

Mercer SJ, Knight JS, Toh SK, Walters AM, Sadek SA, Somers SS (2004) Implementation of a specialist-led service for the management of acute gallstone disease. Br J Surg 91(4):504–508PubMedCrossRef

24.

Stephens MR, Beaton C, Steger AC (2010) Early cholecystectomy after acute admission with cholecystitis: how much work? World J Surg 34(9):2041–2044PubMedCrossRef

25.

Zhu B, Zhang Z, Wang Y, Gong K, Lu Y, Zhang N (2012) Comparison of laparoscopic cholecystectomy for acute cholecystitis within and beyond 72 h of symptom onset during emergency admissions. World J Surg 36(11):2654–2658PubMedCrossRef

26.

Banz V, Gsponer T, Candinas D, Güller U (2011) Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg 254(6):964–970PubMedCrossRef

27.

Schäfer M, Krähenbühl L, Büchler MW (2001) Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 182(3):291–297PubMedCrossRef

28.

Colonval P, Navez B, Cambier E, Richir C, de Pierpont B, Scohy JJ, Guiot P (1997) Is laparoscopic cholecystectomy effective and reliable in acute cholecystitis? Results of a prospective study of 221 pathologically documented cases. Ann Chir 51(7):689–696PubMed

29.

Borzellino G, Sauerland S, Minicozzi AM, Verlato G, Di Pietrantonj C, de Manzoni G, Cordiano C (2008) Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc 22(1):8–15PubMedCrossRef

30.

Botaitis S, Pitiakoudis M, Perente S, Tripsianis G, Polychronidis A, Simopoulos C (2012) Laparoscopic cholecystectomy in acute cholecystitis: an analysis of the risk factors. S Afr J Surg 50(3):62, 64, 68

31.

Giger UF, Michel JM, Opitz I, Th Inderbitzin D, Kocher T, Krähenbühl L, Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) Study Group (2006) Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database. J Am Coll Surg 203(5):723–728PubMedCrossRef

Title: Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients
Authors: Luca Degrate
Arianna Libera Ciravegna
Margherita Luperto
Marcello Guaglio
Mattia Garancini
Matteo Maternini
Laura Giordano
Fabrizio Romano
Luca Gianotti
Franco Uggeri
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1131-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2013

Continuous irrigation around pancreatic remnant decreases pancreatic fistula-related intraabdominal complications after distal pancreatectomy

Molecular diagnostics of pancreatic cysts

Isolated caudate lobectomy with pancreatoduodenectomy for a bile duct cancer

Surgical strategy for T2 and T3 gallbladder cancer: is extrahepatic bile duct resection always necessary?

ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery—the ENERCON systematic review and network meta-analysis

Sorafenib treatment is save and may affect survival of recurrent hepatocellular carcinoma after liver transplantation