Korean J Hepatobiliary Pancreat Surg.  2013 May;17(2):60-65. 10.14701/kjhbps.2013.17.2.60.

Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients

• Lee W
• Kwon J

• KMID: 1429980
• DOI: http://doi.org/10.14701/kjhbps.2013.17.2.60

Abstract

BACKGROUNDS/AIMS
There is debate on the timing of cholecystectomy in acute cholecystitis. Although there is a recent trend toward early laparoscopic cholecystectomy (eLC), that is, within 72 hours of symptom onset, some surgeons still prefer delayed operations, or operations after several weeks, expecting subsidence of the inflammation and therefore a higher chance of avoiding open conversion and minimizing complications. Our experience of LC for 10 years was reviewed retrospectively for the timing of the operation and perioperative outcomes, focusing on evaluating the feasibility of delayed LC (dLC).
METHODS
The severity of the acute cholecystitis was classified into three grades: easily responding to antibiotics and mostly symptom-free (mild, grade I), symptoms persisting during the treatment (moderate, grade II), and worsening into a septic state (severe, grade III).
RESULTS
Among 353 cholecystectomy patients, grade I (N=224) patients had eLC in 152 cases and dLC in 72 cases. Grade II (N=117) patients had eLC in 103 cases and 12 had dLC. All grade III patients (N=12) underwent open cholecystectomy. In Grade I patients, when the operation was delayed, there were fewer open conversion cases compared to eLC patients (20.45% vs 7.69%) (p<0.05), and complications also were decreased (p>0.05). Grade II patients' rate of open conversions (58.3% vs 44.2%) and complications (25.0% vs 19.5%) increased when the operations were delayed compared with eLC patients (p<0.05). In grade I and II patients, the most common reason for open conversion was bleeding, and the most common complication was also bleeding.
CONCLUSIONS
For patients with cholecystits that easily responds to antibiotics (grade I), dLC showed a higher laparoscopic success rate than eLC at the expense of prolonged treatment time and examinations, With moderate to severe cholecystitis (grade II, III), however, there was no room for delayed operations.

Keyword

Laparoscopy; Cholecystectomy; Delayed cholecystectomy

MeSH Terms

Anti-Bacterial Agents
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystitis
Cholecystitis, Acute
Hemorrhage
Humans
Inflammation
Laparoscopy
Retrospective Studies
Anti-Bacterial Agents

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