Role of Early Laparoscopic Cholecystectomy in Preventing Complications of Acute Cholecystitis (original) (raw)
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National Journal of Medical Research, 2025
"Background: This study compares early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with acute calculous cholecystitis to determine the optimal timing for surgery. The study aims to assess the outcomes, complications, and safety of both approaches. Methods: A prospective, comparative study was conducted on 94 patients diagnosed with acute calculous cholecystitis. Patients were randomized into two groups: ELC (Group E), performed within 72 hours of symptom onset, and DLC (Group D), performed 6–12 weeks after initial conservative management. Data on demographic characteristics, clinical features, intraoperative findings, and postoperative outcomes were collected and analyzed. Statistical analysis was conducted using SPSS software, with significance set at p <0.05. Results: ELC was associated with a shorter total hospital stay and reduced complications compared to DLC. However, the Group D showed a higher rate of conversion to open cholecystectomy and longer operative time. Both groups had similar rates of bile duct injuries and postoperative infections. No significant difference was observed in mortality between the two groups. Conclusion: ELC is a safe and effective approach for acute calculous cholecystitis, offering benefits in reduced hospital stay and complications. DLC, while feasible, may lead to increased operative challenges and longer recovery times."
Comparative Operative Outcomes of Early and Delayed Cholecystectomy for Acute Cholecystitis
Annals of Surgery, 2014
Objective: To compare the operative outcomes of early and delayed cholecystectomy for acute cholecystitis. Background: Randomized trials comparing early to delayed cholecystectomy for acute cholecystitis have limited contemporary external validity. Furthermore, no study to date has been large enough to assess the impact of timing of cholecystectomy on the frequency of serious rare complications including bile duct injury and death. Methods: This is a population-based retrospective cohort study of patients emergently admitted to hospital with acute cholecystitis and managed with cholecystectomy over the period of April 1, 2004, to March 31, 2011. We used administrative records for the province of Ontario, Canada. Patients were divided into 2 exposure groups: those who underwent cholecystectomy within 7 days of emergency department presentation on index admission (early cholecystectomy) and those whose cholecystectomy was delayed. The primary outcome was major bile duct injury requiring operative repair within 6 months of cholecystectomy. Secondary outcomes included major bile duct injury or death, 30-day postcholecystectomy mortality, completion of cholecystectomy with an open approach, conversion among laparoscopic cases, and total hospital length of stay. Propensity score methods were used to address confounding by indication. Results: From 22,202 patients, a well-balanced matched cohort of 14,220 patients was defined. Early cholecystectomy was associated with a lower risk of major bile duct injury [0.28% vs 0.53%, relative risk (RR) = 0.53, 95% confidence interval [CI]: 0.31-0.90], of major bile duct injury or death (1.36% vs 1.88%, RR = 0.72, 95% CI: 0.56-0.94), and, albeit non-significant, of 30-day mortality (0.46% vs 0.64%, RR = 0.73, 95% CI: 0.47-1.15). Total hospital length of stay was shorter with early cholecystectomy (mean difference 1.9 days, 95% CI: 1.7-2.1). No significant differences were observed in terms, open cholecystectomy (15% vs 14%, RR = 1.07, 95% CI: 0.99-1.16) or in conversion among laparoscopic cases (11% vs 10%, RR = 1.02, 95% CI: 0.93-1.13).
World Journal of Gastroenterology, Hepatology and Endoscopy, 2020
Acute cholecystitis is the most common cause of hospitalization for gastrointestinal disease & one of the Hepatopancreatobiliary emergencies , 90-95% of cases due to gallbladder stones, worldwide 10-15% of populations have gallbladder stones, only 1-4% become symptomatic each year, laparoscopic cholecystectomy is the definitive treatment. Previously, laparoscopic cholecystectomy was not advised in patient with acute cholecystitis & treated conservatively with the usual approach consists of initial control of inflammation with intravenous antibiotics followed by delayed laparoscopic cholecystectomy 6-8 weeks, this was due to fear of increase morbidity & high rate of conversion to open surgery, also waiting period for surgery will cause more fibrosis, adhesion, hyper vascularity & necrosis with time, also will increase the risk of gallstones morbidity including: CBD stones, Gallstone pancreatitis, recurrent of acute disease. Laparoscopy has become now the cherished art of practice of surgery across the globe & Laparoscopic cholecystectomy has become affordable , beneficial and practicable by majority of surgeons, the timing of cholecystectomy in patients with acute cholecystitis has been a contentious issue for a long time & several clinical trials have discussed the optimal timing of laparoscopic surgery for acute cholecystitis, though samples were small in size, proved that early laparoscopic cholecystectomy in acute cholecystitis is feasible, safe, and cheaper and requires shorter hospitalization especially with the revolution in the laparoscopic surgery, as the experience and confidence of surgeons in laparoscopic cholecystectomy rose up because in the whole world the incidence of acute cholecystitis increasing with time & associated with significant socioeconomic costs, however, laparoscopic cholecystectomy for acute cholecystitis has not become routine, because the timing and approach to the surgical management in patients with acute cholecystitis is still a matter of controversy .
A Comparative Study of Early Versus Interval Cholecystectomy in a Case of Acute Cholecystitis
International journal of scientific research, 2012
Introduction: In present days, there is controversy regarding superiority of early versus interval laparoscopic cholecystectomy Objectives : To study and compare early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy with regards to benefits and harms. Outcome measures : • Conversion to open cholecystectomy, • Operating time, • Bile duct injury, • Unfavorable intra-operative inadvertent events & • Total Hospital stay. Conclusion : Even though, there is no significant different in these two intervention, Early cholecystectomy is safer & has definate socio-economical advantage in reducing total hospital stays.
Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis
Surgery Research and Practice, 2015
Background. The role of early laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis is not yet established. The aim of our prospective randomized study was to evaluate the safety and feasibility of early LC for acute cholecystitis and to compare the results with delayed LC.Methods. Between March 2007 to December 2008, 50 patients with diagnosis of acute cholecystitis were assigned randomly to early group,n=25(LC within 24 hrs of admission), and delayed group,n=25(initial conservative treatment followed by delayed LC, 6–8 weeks later).Results. We found in our study that the conversion rate in early LC and delayed LC was 16% and 8%, respectively, Operation time for early LC was 69.4 min versus 66.4 min for delayed LC, postoperative complications for early LC were 24% versus 8% for delayed LC, and blood loss was 159.6 mL early group versus 146.8 mL for delayed group. However early LC had significantly shorter hospital stay (4.1 days versus 8.6 days).Conclusions. Earl...
SSR Institute of International Journal of Life Sciences, 2020
Background: Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic gallbladder stone. The common opinion about the treatment of acute cholecystitis (AC) is initially conservative treatment due to preventing complications of inflammation and following delayed laparoscopic cholecystectomy after 6-8 weeks. However, with the increase of laparoscopic experience in recent years, early LC has become more common. Methods: This study included 40 patients of AC with comparison between early (20 patients) and delayed (20 patients) LC. In AC, initial conservative treatment was given and early LC performed within 72 hours and delayed LC was done after 6-8 weeks, both groups monitored since admission, during operations, and along the postoperative (PO) period. Results: There was a significant difference in the successful LC conversion rates out of 20 each (20 early versus 19 delayed, p-value= 0.000), and conversion, open cholecystectomy (OC) to delay cholecystectomy conversion rates 5% or complication was found in delayed out of 20 in adhesion was 20%, wound Infection 1% and pain 15%; hospital stay was more significant in delayed LC 0.007 and USG finding in compared between early and delayed, was more common in delayed LC. Conclusion: Intraoperative and PO complications being associated more with delayed LC as compared to early LC, so early LC should be preferred for treatment of AC.
A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis
Kathmandu University Medical Journal, 2009
Aims and Objectives: To compare the outcome in early vs. delayed laparoscopic cholecystectomy in terms of frequency of intra-operative and postoperative complications and to determine the rate and reasons for conversion. in all patients with the diagnosis of acute calculus cholecystitis. Results: Out of 145 cases, 50 cases were included in our study where 12 (24%) patients were males and 38 (76%) were females (M:F=1:3.16). The mean (SD) age of patients in early and delayed groups were 42.68 yrs. (14.18) and 40.26 yrs. (11.62) respectively. The mean (SD) duration of symptoms in early successful and converted groups were 109.24 hrs. (43.66) and 132 hrs. (49.96) respectively and the mean (SD) duration of symptoms in delayed successful and converted groups were 15.36 months (13.88) and 41 months respectively. In early group, 17 (68%) patients had total leukocyte count more than 10,000/cmm and they had ultrasound ¿ ndings suggestive of acute cholecystitis. Out of 25 patients in early group, seven had jaundice and ten had deranged liver function in the preoperative period. In early group 4 (16%) patients; and in delayed group 3 (12%) had to be converted to open cholecystectomy (P=1.00). In early group 10 (40%) and in delayed 5 (20 %) cases had intra-operative complications (P=0.122). The total hospital stay was longer in the delayed group. The postoperative hospital stay in early and delayed converted groups were higher than early and delayed successful group (P=0.081, P=0.082). Conclusion: Both early and delayed laparoscopic cholecystectomy is possible and safe in the treatment of acute cholecystitis.
Early laparoscopic cholecystectomy in acute cholecystitis: safety and advantages
International Surgery Journal, 2016
Background: Cholecystectomy is a widely performed procedure all over world though popularized late in India. Today, Laparoscopic cholecystectomy is the method of choice to remove gall bladder. A concern exists in the minds of surgeons when it comes to immediate removal of an acutely inflammed gall bladder, laparoscopically. To analyze this hesitation, statistically, this study has been carried out. Methods: A prospective and randomized study was conducted among 66 patients from March 2013 to February 2016. Thirty three patients presenting with acute calculous cholecystitis were subjected to delayed laparoscopic cholecystectomy (Group A) after an initial conservative treatment and gap of 6-8 weeks. Another group of 33 patients presenting with acute calculous cholecystitis were taken up for laparoscopic cholecystectomy within 72 hours of onset of symptoms (Group B). Results obtained, in both the groups, under different headings were compared and analyzed. Results: Time taken for early laparoscopic cholecystectomy was significantly higher than that for delayed laparoscopic cholecystectomy. Cost of treatment and total hospital stay in delayed group was significantly high as compared to early group. No significant difference was found in incidence of conversion rate, common bile duct (CBD) and gastrointestinal tract (GIT) injury, requirement of drain, postoperative pain and analgesia requirement and port related complications. Conclusions: Early cholecystectomy in acute cholecystitis is feasible, safe, cheaper and requires shorter hospital stay, if, performed within 72 hours of onset of symptoms.
Outcomes of Early Laparoscopic Cholecystectomy in Acute Cholecystitis
2021
Original Research Article The optimal timing to perform cholecystectomy in patients with acute cholecystitis remains controversial. Many surgeons prefer interval cholecystectomy over early and believe it to be safer for patient and easier for the surgeon. There are many studies over no difference in outcome of early cholecystectomy with respect to interval cholecystectomy in patients of acute cholecystitis. The aim of this study is to assess outcome of early laparoscopic cholecystectomy (ELC) for acute cholecystitis in a rural setup. The series consisted of 50 patients who underwent ELC for acute cholecystitis from June 2017 to December 2020. Multiple parameters like hospital stay, duration of surgery, conversion to open cholecystectomy, cost effectiveness were assessed for these patients post operatively. Our study confirms that early cholecystectomy in acute cholecystitis does not increase morbidity in patient and is as safe as delayed cholecystectomy.
Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a comparative study
International Surgery Journal, 2018
A variety of treatments have been offered from time to time for gall bladder (GB) diseases. Cholecystectomy has stayed as one of the best and most accepted treatment modalities for GB diseases. Every year, about 500,000 people all over the world have their gall bladders removed. Acute cholecystitis was traditionally treated with antibiotics and supportive treatment and cholecystectomy was performed after 6 weeks of the acute episode. 1-4 The potential hazard of severe complications, if surgery is performed in an area of distorted anatomy caused by acute inflammation was the major concern. 5 Till date laparoscopic cholecystectomy is considered the 'gold standard' in the treatment of cholelithiasis/cholecystitis and highlights all the ABSTRACT Background: Laparoscopic cholecystectomy is now the procedure of choice for patient presenting with acute cholecystitis unless it is contraindicated for technical reason or safety. An attempt was made to compare the outcome and postoperative complications of early vs delayed laparoscopic cholecystectomy in acute cholecystitis. Methods: Fifty patients aged 18 to 64 years having acute cholecystitis admitted for laparoscopic cholecystectomy were included. They were divided into two groups, early (less than 72 hours) and delayed (more than 72 hours up to 6 weeks) laparoscopic cholecystectomy. The patients were followed for three months after the surgery. The primary outcome measures were conversion to open surgery and postoperative complications whereas secondary outcome measures were hospital stay and return to full activity. Comparison of quantitative variables and qualitative variables was done using unpaired student's "t" test and chi-square test/ Fisher's exact test respectively. Results: Conversion to open cholecystectomy (p = 0.007) and post-operative complications (p = 0.032) were significantly less in early laparoscopic cholecystectomy group compared to delayed laparoscopic cholecystectomy group. Mean days of hospital stay (4.9 versus 7.4 with p = 0.001) and mean days of return to full activities (12.6 vs 16.3 days with p = 0.001) was significantly less in early laparoscopic surgery group compared to delayed laparoscopic cholecystectomy group. Mean duration of surgery was significantly less in early laparoscopic surgery group as compared to delayed laparoscopic surgery group (69.3 versus 108.5 minutes, with p = 0.001). Conclusions: Early laparoscopic cholecystectomy is better choice than delayed laparoscopic cholecystectomy in acute cholecystitis.