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Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients

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Abstract

Purpose

Early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute cholecystitis (AC), but the optimal surgical timing is controversial. The aim of this study was to retrospectively verify the outcome of patients with AC according to different timing of cholecystectomy.

Methods

Patients undergoing cholecystectomy for AC from 2006 to 2012 were stratified into two groups: initial admission cholecystectomy (IAC) and delayed cholecystectomy (DC, after at least 4 weeks). Among IAC, a subgroup undergoing immediate cholecystectomy (IC, within 72 h of symptom onset) was further analyzed.

Results

Three-hundred and sixteen consecutive patients were studied. IAC group included 262 patients (82.9 %) and DC group included 54 patients (17.1 %). The two groups were similar in conversion rate, operation length, and overall complication rate. The total length of hospitalization was longer in DC patients (p = 0.005). Among DC patients, 25.9 % required re-hospitalization while waiting an elective procedure. In the group undergoing IC (66 patients), conversion rate, length of operation, and postoperative morbidity were similar to that of the IAC group. Length of stay was shorter in IC group (p < 0.001). Multivariate analysis identified moderate–severe AC grading and ASA score ≥ 3 as predictors of postoperative complications.

Conclusions

The timing of cholecystectomy for AC does not seem to affect conversion rate and postoperative morbidity. Therefore the 72-h period should not be considered a strict limit to perform LC, provided that the operation is carried out during the initial hospital admission.

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Acknowledgments

We would like to thank Francesca Bagnariol for data collection and completion of the database.

Conflicts of interest

Drs. Luca Degrate, Arianna Libera Ciravegna, Margherita Luperto, Marcello Guaglio, Mattia Garancini, Matteo Maternini, Laura Giordano, Fabrizio Romano, Luca Gianotti, Franco Uggeri have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy

    Luca Degrate, Arianna Libera Ciravegna, Margherita Luperto, Marcello Guaglio, Mattia Garancini, Matteo Maternini, Fabrizio Romano, Luca Gianotti & Franco Uggeri

  2. Biostatistic Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, MI, Italy

    Laura Giordano

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  1. Luca Degrate
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Correspondence to Luca Degrate.

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Degrate, L., Ciravegna, A.L., Luperto, M. et al. Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients. Langenbecks Arch Surg 398, 1129–1136 (2013). https://doi.org/10.1007/s00423-013-1131-0

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