A Study of Optimum Timing of Laparoscopic Cholecystectomy in Patients Presenting with Acute Cholecystitis

BACKGROUND Laparoscopic cholecystectomy is difficult in acute cholecystitis because the gall bladder is usually thick walled and tensely distended. If the inflammation of the gall bladder extends to the porta hepatis the dissection becomes difficult. The normally thin minimally adherent tissue that invest the cystic duct and artery is markedly thickened and oedematous and may not readily separate from these structures with the usual blunt dissection technique. The duct wall also may be oedematous, thus making its external diameter similar to gall bladder neck and common bile duct. Moreover, operative difficulty substantially increases with time. It is believed that laparoscopic cholecystectomy in acute cholecystitis is having more operative time, more conversion rate and more chance of injury. METHODS We did an observational study to determine the safety, benefits and drawbacks of laparoscopic cholecystectomy within 72 hours of symptoms (and beyond that). RESULTS Total 325 patients underwent laparoscopic cholecystectomy in acute cholecystitis. Among them 110 patients were operated within 72 hours of appearance of symptoms while 215 patients were operated upon after 72 hours of appearance of symptoms. The mean duration of surgery was significantly (p< 0.001) less in early surgery group. There was no conversion. There was no serious intra operative complication (injury) in early group. There was no statistically significant post-operative complication in either group. Post-operative stay was significantly less (p<0.004) in early laparoscopic cholecystectomy group. Period of return to work was also significantly less (p<0.001) in early group. CONCLUSIONS Early (within 72 hours of appearance of symptoms) laparoscopic cholecystectomy can be safely advocated in patients of acute cholecystitis. It does not result in increased conversion rate or increased intra operative complication. Moreover it offers benefits shorter post-operative hospital stay and early return to work than laparoscopic cholecystectomy after 72 hours of appearance of symptoms.