Re: JSLS(2008)12: 282–287 Timing of Early Laparoscopic Cholecystectomy for Acute Cholecystitis

OBJECTIVE Although many surgeons advocate early laparoscopic cholecystectomy (LC) in acute cholecystitis, debate still exists regarding its optimal timing. This study compares the outcome of LC performed within and after 72 hours of admission in patients with acute cholecystitis. METHODS Between January 2001 and December 2006, LC was performed in 196 consecutive patients with acute cholecystitis. Laparoscopic cholecystectomy was performed within 72 hours of admission in 82 patients (group 1) and after 72 hours in 114 patients (group 2). Data were collected prospectively. RESULTS Both groups were matched in terms of age, sex, body mass index, fever, white blood cell count, and ultrasound findings. The overall conversion rate was 5%. No significant difference existed in conversion rates between group 1 (2.4%) and group 2 (7%) (P=0.3). The operation time (105 versus 126 minutes, P=0.008), complications (0% versus 6%, P=0.02), and total hospital stay (5 versus 12 days, P<0.001) were significantly reduced in group 1. No deaths occurred in this study. CONCLUSION Early LC can be performed safely in most patients with acute cholecystitis, but we recommend intervention within 72 hours of admission to minimize the complication rate and shorten the operation time and total hospital stay.