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Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis

Received: 16 March 2016     Accepted: 17 March 2016     Published: 18 April 2016
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Abstract

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.

Published in Journal of Surgery (Volume 4, Issue 3-1)

This article belongs to the Special Issue Surgical Infections and Sepsis

DOI 10.11648/j.js.s.2016040301.16
Page(s) 29-33
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Acute, Cholecystectomy, Laparoscopic

References
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[2] Cuschieri A Approach to the treatment of acute cholecystitis: open surgical, laparoscopic or endoscopic? Endoscopy 1993; 25: 397–8.
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[6] Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC et al Randomised trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.Br J Surg 1998; 85: 764–7.
[7] Koo K, Thirlby R Laparoscopic cholecystectomy in acute cholecystitis What is the optimal timing for operation? Arch Surg 1996; 131: 540–4.
[8] Knight J, Mercer S, Somers S, Walters AM, Sadek SA, Toh SK Timing of urgent laparoscopic cholecystectomy does not influence conversion rate Br J Surg 2004; 91: 601–4.
[9] Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N et al Laparoscopic management of acute cholecystitis Prognostic factors for success Surg Endosc 1996; 10: 1045–9.
[10] Teixeira JP, Saraiva AC, Cabral AC, Barros H, Reis JR, Teixeira A Conversion factors in laparoscopic cholecystectomy for acute cholecystitis Hepatogastroenterology 2000; 47: 626–30.
[11] Garber S, Korman J, Cosgrove J, Cohen J Early laparoscopic cholecystectomy for acute cholecystitis Surg Endosc 1997; 11: 347–50.
[12] Larson GM, Vitale GC, Casey J, Evans JS, Gilliam G, Heuser L et al Multi-practice analysis of laparoscopic cholecystectomy in 1983 patients Am J Surg 1992; 163: 221–6.
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[16] Skouras C1, Jarral O, Deshpande R, Zografos G, Habib N, Zacharakis E Is early laparoscopic cholecystectomy for acute cholecystitis preferable to delayed surgery? Best evidence topic (BET) Int J Surg. 2012; 10(5):250-8 doi: 10.1016/j.ijsu.2012.04.012 Epub 2012 Apr 21.
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  • APA Style

    Abdallah M Taha, Mohamed Yousef A., Asmaa Gaber R. (2016). Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis. Journal of Surgery, 4(3-1), 29-33. https://doi.org/10.11648/j.js.s.2016040301.16

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    ACS Style

    Abdallah M Taha; Mohamed Yousef A.; Asmaa Gaber R. Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis. J. Surg. 2016, 4(3-1), 29-33. doi: 10.11648/j.js.s.2016040301.16

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    AMA Style

    Abdallah M Taha, Mohamed Yousef A., Asmaa Gaber R. Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis. J Surg. 2016;4(3-1):29-33. doi: 10.11648/j.js.s.2016040301.16

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  • @article{10.11648/j.js.s.2016040301.16,
      author = {Abdallah M Taha and Mohamed Yousef A. and Asmaa Gaber R.},
      title = {Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis},
      journal = {Journal of Surgery},
      volume = {4},
      number = {3-1},
      pages = {29-33},
      doi = {10.11648/j.js.s.2016040301.16},
      url = {https://doi.org/10.11648/j.js.s.2016040301.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.s.2016040301.16},
      abstract = {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.},
     year = {2016}
    }
    

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  • TY  - JOUR
    T1  - Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis
    AU  - Abdallah M Taha
    AU  - Mohamed Yousef A.
    AU  - Asmaa Gaber R.
    Y1  - 2016/04/18
    PY  - 2016
    N1  - https://doi.org/10.11648/j.js.s.2016040301.16
    DO  - 10.11648/j.js.s.2016040301.16
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 29
    EP  - 33
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.s.2016040301.16
    AB  - 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.
    VL  - 4
    IS  - 3-1
    ER  - 

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Author Information
  • Department of General Surgery, Faculty of Medicine, South Valley University, Qena, Egypt

  • Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, Egypt

  • Department of General Surgery, Faculty of Medicine, South Valley University, Qena, Egypt

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