Abstract
Forty-six patients with acute cholecystitis were examined for the optimal operation time, by dividing them into the following three groups on the basis of treatment:
1. Emergency operation group (17 cases)-cholecystectomy within 48 hours after the onset of symptoms.
2. Early operation group (18 cases)-initial conservative therapy for 3 to 7 days followed by cholecystectomy.
3. Delayed operation group (11 cases)-more than 8 days conservative therapy followed by cholecystectomy.
Mean operation time of each group was 1, 5, and 13 days after the onset, respectively. The ratio of improvement of illness was only 30% within 7 days after the onset of symptoms, especially in patients older than 70 years of age, there were no improvements of illness. Necrosis of the gallbladder was seen in 8 patients (44.4%) of the early operation group and 3 patients (27.2%) of the delayed operation group. There were no differences among the three groups on intraoperative blood loss and surgery time, but the incidence of complications was significantly higher in the early operation group. The hospital stay was shorter in the emergency operation group, to a significant degree.
These results indicate that the emergency operation is the treatment of choice in acute cholecystitis, especially in patients older than 70 years. However in such patients where conservative therapy is required, because of poor operation conditions surgery should be done no earlier than 14 days.
