Early Laparoscopic Cholecystectomy for Acute Cholecystitis. When Do Risks Seem Imminent?

Introduction

Surgery for acute cholecystitis is time-critical; the timing of laparoscopic cholecystectomy in acute cholecystitis patients has historically been controversial because of a perceived increased risk of complications. The aim is to evaluate the impact of operative timing within 7 days of symptom onset on patient outcomes.

Method

A retrospective cohort study of patients who underwent laparoscopic cholecystectomy within 7 days after being admitted for acute cholecystitis between January 2016 and December 2021 in the Acute Care Surgery section. The study was conducted by dividing the study population into seven groups based on the operation day for each patient to evaluate the impact of operative timing on postoperative outcomes and compare the clinical results to determine how long the operation will be safe.

Results

Within the study period, 3299 acute cholecystitis patients underwent laparoscopic cholecystectomy. The mean age was 42.4 years, with 50.1% of them being women and 49.9% of them being men. The rate of patients older than 65 years was 6.2%. A total of 237 patients (7.18%) had complications; the conversion to open surgery occurred in 27 patients (0.8%); and the overall reoperation rate was 0.5% (17 patients).

Conclusion

Our study shows that delays in laparoscopic cholecystectomy scheduling for acute cholecystitis after 3 days from the onset of symptoms can lead to a longer operative duration as well as a longer hospital stay. However, it does not significantly impact overall complications and reoperation rates, allowing a feasible and safe procedure to be performed within 7 days.