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

World Journal of Surgery volume 31, pages 1300–1303 (2007)Cite this article

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An Erratum to this article was published on 04 October 2008

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.

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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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Authors and Affiliations

  1. Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK

    Sirwan M. Hadad, Jayant S. Vaidya, Lee Baker, Hoey C. Koh, Timothy P. Heron & Alastair M. Thompson

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  1. Sirwan M. Hadad
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  2. Jayant S. Vaidya
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  3. Lee Baker
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  4. Hoey C. Koh
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  5. Timothy P. Heron
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  6. Alastair M. Thompson
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Corresponding author

Correspondence to Sirwan M. Hadad.

Additional information

The abstract was presented at the British Journal of Surgery Prize Session of the 7th World Congress of the International Hepato-Pancreato-Biliary Association, 10th Annual Meeting of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland in Edinburgh, UK, September 2006.

An erratum to this article can be found at http://dx.doi.org/10.1007/s00268-008-9750-2

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Hadad, S.M., Vaidya, J.S., Baker, L. et al. Delay from Symptom Onset Increases the Conversion Rate in Laparoscopic Cholecystectomy for Acute Cholecystitis. World J Surg 31, 1300–1303 (2007). https://doi.org/10.1007/s00268-007-9050-2

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  • DOI: https://doi.org/10.1007/s00268-007-9050-2

Keywords

  • Conversion Rate
  • Laparoscopic Cholecystectomy
  • Acute Cholecystitis
  • Obstructive Jaundice
  • Bile Duct Injury