Commentary to paper “Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 hours of symptom onset”

Excerpt

Cholelithiasis is a daily diagnosed pathology in clinical practice, all over the world. Gallstone disease is prevalent in 10% of the population, and up to 23% can develop into acute cholecystitis [1]. Laparoscopic cholecystectomy (LC) represents nowadays the “gold standard” for cholecystolithiasis since the late 1990s, but the best timing to treat a challenging concomitant condition, such as an acute cholecystitis, is still debated. As operating acutely was previously believed to be more technically challenging due to distorted anatomy from acute inflammation, a cooling off period has been advocated, employing a conservative treatment with empiric antibiotic therapy followed by elective surgery several weeks later. Conversely, this approach could require further readmissions for recurrent episodes; furthermore, chronic inflammation, leading to fibrosis and adhesions, may make for a difficult dissection in delayed LC. Following this background, several authors advocate an early surgery, within first 72 h from the onset of the symptoms, whereas others assume acceptable to wait even 4–6 weeks or more [1]. The debated key issues reside in intraoperative complications, needing a laparotomic conversion, operative time, cost containment, and reduction of length of stay (LOS), evaluating the subsequent quality of life, and improving the safety of the surgical act. …