Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis

Introduction: Acute cholecystitis is a relatively common complication of gallstones It can lead to significant morbidity and mortality from potentially life-threatening complications such as empyema, gallbladder gangrene and gallbladder perforation It presents as a surgical emergency and usually requires hospitalization for management Laparoscopic cholecystectomy is advocated for acute cholecystitis; however, the timing of cholecystectomy and the value of the additional treatments have been a matter of controversy Aim: To compare the outcome of early versus delayed laparoscopic cholecystectomy in cases of non-complicated acute cholecystitis, as its place remains controversial in the management of acute cholecystitis due to a high reported incidence of bile leaks and conversion rate Design: Prospective interventional comparative study Methods: 120 Patients admitted to Qena and Aswan universities’ hospitals with acute cholecystitis over two years period (2013-2015) were included in this study An early laparoscopic cholecystectomy (ELC), within 7 days from onset of symptoms, for 50 patients, and delayed Laparoscopic cholecystectomy (DLC) after 6 weeks of conservative treatment for 70 patients was performed Demographic details, operative findings, conversion to open surgery, operative time, complications, timing of endoscopic retrograde cholangiopancreatography (ERCP) and hospital stay for all those patients were recorded Statistical analysis was performed by SPSS version 18 Results: There was insignificant difference in the conversion rates (2 in ELC group versus 2 DLC group, p value: 0.555), post-operative hospital stay (2 days vs 1.5days, p value: 0.375) However, operative time was significantly more in the ELC group (85 minutes versus 70 minutes, p value: 0.023) Postoperative ERCP was required in 2 patients in ELC group and one patient in DLC group Pre-operative ERCP was required in 2 patients in delayed group 40% of patients (48) had previous admissions with similar symptoms Conclusion: ELC for uncomplicated acute cholecystitis is technically demanding surgery, but it is safe and do not have increased complication rate than DLC It decreases re-admission rate and overall hospital stay.