World Journal of Surgery

, Volume 31, Issue 6, pp 1300–1303 | Cite as

Delay from Symptom Onset Increases the Conversion Rate in Laparoscopic Cholecystectomy for Acute Cholecystitis

  • Sirwan M. Hadad
  • Jayant S. Vaidya
  • Lee Baker
  • Hoey C. Koh
  • Timothy P. Heron
  • Alastair M. Thompson
Original Article

Abstract

Background

Randomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate.

Methods

We performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis.

Results

Of patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0–2 days, 3–4 days, 5–6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions.

Conclusions

Early intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.

Keywords

Conversion Rate Laparoscopic Cholecystectomy Acute Cholecystitis Obstructive Jaundice Bile Duct Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors are grateful to the Medical Records Department, Ninewells Hospital and Medical School, for support in retrieving case notes.

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Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Sirwan M. Hadad
    • 1
  • Jayant S. Vaidya
    • 1
  • Lee Baker
    • 1
  • Hoey C. Koh
    • 1
  • Timothy P. Heron
    • 1
  • Alastair M. Thompson
    • 1
  1. 1.Department of Surgery and Molecular OncologyNinewells Hospital and Medical SchoolDundeeUK

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