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Delayed Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: Is it Time for a Change?

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Abstract

Background

Our aim was to evaluate the advantages and limitations of delayed laparoscopic cholecystectomy (LC) in a tertiary center.

Materials and methods

A retrospective analysis of all patients admitted to our institution with acute calculous cholecystitis (ACC) between January 2003 and December of 2012 was performed. Data collected included patient demographics and comorbidities, presenting symptoms, laboratory findings, imaging results, length of stay (LOS), time to surgery, and surgical complications.

Results

A total of 1078 patients were admitted with ACC. There were 593 females (55%), and the mean age was 57 ± 0.6 years. Mean LOS at initial admission, re-admission until surgery, and following surgery was 7.9 ± 0.2, 1.5 ± 0.1, and 3.4 ± 0.2 days, respectively. Percutaneous cholecystostomy (PC) tube was inserted in 24% of the patients. Only 640 (59%) patients eventually underwent LC. Mean time to surgery was 97 ± 9.8 days, and 16.4% of patients were readmitted in this time period resulting in a mean total LOS of 10.6 ± 0.2 days. Conversion rate to open surgery was 5.8% and bile duct injury occurred in 1.1%. Postoperative complications occurred in 9.8% of the patients, and 30-day mortality was 0.6%. Patients with more severe inflammation according to Tokyo Criteria grade were more likely to undergo PC, were more likely to be readmitted while waiting for LC, and also had more postoperative complications.

Conclusions

Delayed LC is associated with significant loss of follow-up, long LOS, and higher than expected use of PC. Conversion rates are lower than in the literature while rates of bile duct injury and mortality are comparable. We believe these data as well as the available literature are sufficient to change our hospital policy regarding the surgical treatment of ACC from delayed to early same admission surgery in appropriate cases.

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    Authors and Affiliations

    1. Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel

      Jonathan B. Yuval, Ido Mizrahi, Haggi Mazeh, Daniel J. Weiss, Gidon Almogy, Miklosh Bala, Eran Kuchuk, Baha Siam, Ahmed Eid & Alon J. Pikarsky

    2. Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel

      Natalia Simanovsky

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    1. Jonathan B. Yuval
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    Correspondence to Jonathan B. Yuval.

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    All the authors have no conflict of interest related to the manuscript and did not receive grants for the work involved.

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    Jonathan B. Yuval and Ido Mizrahi contributed equally to the preparation of this manuscript.

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    Yuval, J.B., Mizrahi, I., Mazeh, H. et al. Delayed Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: Is it Time for a Change?. World J Surg 41, 1762–1768 (2017). https://doi.org/10.1007/s00268-017-3928-4

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