Optimal timing of laparoscopic cholecystectomy in acut cholecystitis?

Background: To determine the effect of timing of surgery in patients with acute cholecystitis with respect to duration of procedure, conversion rate and morbidity. Patients and Methods: All patients that underwent laparoscopic cholecystectomy in the same admission for acute cholecystitis between May 2009 to January 2010 were included in the study. Patients were divided into 'early' and 'late' groups. 'Early' were those that had surgery within 72 hours of onset of symptoms and the 'late' group were those that had surgery after 72 hours of onset of symptoms. Outcome was assessed by comparing: conversion rate, total and post-operative hospital stay, operative time and complications between these two groups. Results: Sixty five patients underwent laparoscopic cholecystectomy for acute cholecystitis. Out of them, 23 patients underwent cholecystectomy within 72 hours from the onset of symptoms (early group), while the remaining 42 patients had laparoscopic cholecystectomy 72 hours after onset of symptoms (late group). The 'early' group had a conversion rate of 13 percent (3/23) while 'late' group had a conversion rate of 42 percent (18/42). Post-operative hospital stay was also significantly longer in patients of the 'late' group (2.8 vs. 2 days). There were five complications in different patients in total. They were all in patients of 'late' group. Conclusion: Early laparoscopic cholecystectomy (within 72 hours of onset of symptoms) in acute cholecystitis is associated with a lower conversion rate, shorter hospital stay and minimal complications. (author)