Outcome of early laparoscopic cholecystectomy in acute cholecystitis
Background: Laparoscopic cholecystectomy was introduced in mid 1980s as treatment of symptomatic gallstone disease. This study was conducted to compare the outcome of early vs interval laparoscopic cholecystectomy in acute cholecystitis. Methods: It was a randomized controlled study conducted at Department of Surgery, DHQ Teaching Hospital, DI Khan from Jan 2018 to Jan 2019. Eighty patients with diagnosis of acute calculous cholecystitis were included in the study and were divided into 2 groups of 40 each. Group-A underwent early laparoscopic cholecystectomy within 72 hours of presentation. Group-B were kept on conservative treatment, discharged after improvement, and readmitted at 6 weeks interval for laparoscopic cholecystectomy. Patients who failed to respond to conservative treatment after 48 hours were operated in the same admission but were kept in group B. Length of stay, intra-operative blood loss, complications, mean operative time, and conversion rate were documented. Results: There were 6 (15%) males and 34 (85%) females in group A, and 5 (12.5%) male and 35 (87.5%) female patients in group B. Mean operating time (79.65±8.33 vs 99.5±10.78 min, p=0.002), mean operative blood loss (52.12±9.99 vs 81.22±8.63 ml, p=0.000), and mean duration of hospital stay (3.1±0.3 vs 8.1±.8 days, p=0.000) were observed in group A and B respectively. Frequency of bile duct injury was higher in group B (0% vs 0.025%), but the difference was not significant (p=0.500). Conclusion: Early laparoscopic cholecystectomy is better regarding hospital stay, early recovery, complications, and conversion rate compared to delayed laparoscopic cholecystectomy with acute cholecystitis.
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Kumar R, Mahi SS, Walia R, Goyal S. Comparison between early and delayed laparoscopic cholecystectomy in acute cholecystitis: A prospective study. Int J Surg 2019;12(3):74–9.
Abou-Saif A, Al-Kawas FH. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol 2002;97(2):249–54.
Shabanzadeh DM. Incidence of gallstone disease and complications. Curr Opin Gastroenterol 2018;34(2):81–9.
Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, et al. The European experience with laparoscopic cholecystectomy. Am J Surg 1991;161(3):385–7.
Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 2005;92(1):44–9.
Hegazy TO, Soliman SS. Early versus interval laparoscopic cholecystectomy for treatment of noncomplicated acute calcular cholecystitis. Egypt J Surg 2018;37(4):543–8.
Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg 2015;18:196–204.
Blum CA, Adams DB. Who did the first laparoscopic cholecystectomy? J Minim Access Surg 2011;7(3):165–8.
Acar T, Kamer E, Acar N, Atahan K, Bağ H, Hacıyanlı M, et al. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy. Pan Afr Med J 2017;26:49.
Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Surg Endosc 2006;20(1):82–7.
Abbasi F, Ahmed S. Laparoscopic cholecystectomy; comparison of early versus delayed laparoscopic cholecystectomy in acute cholecystitis: a randomized control trial. Professional Med J 2019;26(3):474–8.
Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW. Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 2000;66(9):896–900.
Uysal E, Turel KS, Sipahi M, Isik O, Yilmaz N, Yilmaz FA. Comparison of Early and Interval Laparoscopic Cholecystectomy for Treatment of Acute Cholecystitis. Which is Better? A Multicentered Study. Surg Laparosc Endosc Percutan Tech 2016;26(6):e117–121.
Farooq A, Zia L, Khalid M. Outcome of same admission laparoscopic cholecystectomy for acute cholecystitis in a district hospital. Ann King Edward Med Univ 2019;25(1):81–5.
Murray AC, Markar S, Mackenzie H, Baser O, Wiggins T, Askari A, et al. An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK. Surg Endosc 2018;32(7):3055–63.
Mustafa MIT, Mustafa AIT, Chaudhry SM, Mustafa RIT. Early vs Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis. Pak J Med Health Sci 2016;10(2):371–3.
Naeem M, Waheed R, Maroof SA, Ahmad M. Frequency of conversion of lap chole with open cholecystecomy. J Med Sci 2017;25(1):68–71.
Cao AM, Eslick GD, Cox MR. Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case–control studies. Surg Endosc 2016;30(3):1172–82.
Riquelme F, Marinkovic B, Salazar M, Martínez W, Catan F, Uribe-Echevarría S, et al. Early laparoscopic cholecystectomy reduces hospital stay in mild gallstone pancreatitis. A randomized controlled trial. HPB (Oxford) 2020;22(1):26–33.
Discolo A, Reiter S, French B, Hayes D, Lucas G, Tan L, et al. Outcomes following early versus delayed cholecystectomy performed for acute cholangitis. Surg Endosc 2020;34:3204–10.
Altieri MS, Brunt LM, Yang J, Zhu C, Talamini MA, Pryor AD. Early cholecystectomy (<72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York. Surg Endosc 2020;3051–6.
Zafar SN, Obirieze A, Adesibikan B, Cornwell EE 3rd, Fullum TM, Tran DD. Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg 2015;150(2):129–36.
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