Surgical outcome and operative technique of urgent laparoscopic cholecystectomy for acute cholecystitis after 4 Days from symptom onset

Abstract

Background: It is preferable to perform laparoscopic cholecystectomy for acute cholecystitis within 72 h of symptom onset in 2013 Tokyo guideline. The surgical outcome of performing laparoscopic cholecystectomy in the late phase (4-7 days after symptom onset) are unclear. The aim of this study was to clarify the surgical outcome and operative technique of late phase laparoscopic cholecystectomy.

Methods: Between 2005 and 2014, 233 patients underwent urgent laparoscopic cholecystectomy for acute cholecystitis within 7 days. We compared perioperative outcomes between patients who underwent laparoscopic cholecystectomy within 3 days (early phase group) and 4-7 days after symptom onset (late phase group). The gallbladder was easily dissected between the inner and outer layer of subserosa.

Results: There were 193 patients in the early phase group and 40 patients in the late-phase group. Laparoscopic cholecystectomy in the late phase did not influence operation time, the rate of conversion to open surgery, postoperative complications, or postoperative hospital stay. The blood loss were significantly increased in the late phase group (140ml) compared with the early phase group (69ml) but acceptable (p=0.0084).

Conclusions: Late phase urgent laparoscopic cholecystectomy for acute cholecystitis was safely accomplished by experienced surgeons.