Early versus delayed laparoscopic cholecystectomy for lithiasic acute cholecystitis during emergency admissions. Results of a monocentric experience and review of the literature.

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Published Jan 13, 2017
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Vol. 94 No. 8 (2016): Issue Aug 2016

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Mohamed Salah Jarrar
Ibrahim Chouchène
Houssem Fadhl
Rafik Ghrissi
Amine Elghali
Ferhi Fehmi
Hedi Mraidha
Fehmi Hamila
Rached Letaief

Abstract

Abstract
Background: It is established that the standard treatment for lithiasic acute cholecystitis is the laparoscopic cholecystectomie. However, the question of the timing of cholecystectomy remains controversial.
Aim: To compare early laparoscopic cholecystectomies (within 72 hours of symptom onset) and delayed laparoscopic cholecystectomies (beyond 72 hours) for lithiasic acute cholecystitis in terms of intra-operative difficulties and post-operative complications.
Methods: The patients operated on for acute cholecystitis, between January 2007 and December 2012, were included in a retrospective study. They were divided into two groups based on whether surgery was performed before (group A) or after (group B) 72 hours after the onset of symptoms. We conducted a comparison between the two groups.
Results: The two groups were comparable in terms of background, clinico-biological presentation, and radiological findings. The average time of surgery was 111.6 hours after symptom onset.  Duration of surgery was significantly longer for group B (97 minutes versus 82.17 minutes, p = 0.003). There was more conversion in group B than in group A, without significant difference (20% versus 11.6%, p = 0.14). There were no deaths in our series. Specific post-operative complications were comparable between the two groups (wound infection: 3 (B) versus 1 (A), biliary fistula: 8 (B) versus 0 (A), p = Non significant). The post-operative hospital stay was significantly longer in group B (3.34 days versus 1.84, p <10-3).
Conclusion: In case of early laparoscopic cholecystectomy, the conversion rate and post-operative morbidity are comparable to the delayed treatment of acute cholecystitis. But the early surgery can reduce the cost of care, the duration of surgery and the hospital stay.
Key-words : Lithiasic acute cholecystitis ; Laparoscopic cholecystectomy
 

Keywords:

Lithiasic acute cholecystitis ; Laparoscopic cholecystectomy

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References

  1. Yamashita Y, Takada T, Kawarada Y et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines . J Hepatobiliary Pancreat Surg.2007; 14(1):91-7.
  2. Zhu B, Zhang Z, Wang Y et al. Comparison of laparoscopic chholecystectomy for acute cholecystitis within and beyond 72 h of symptom onset during emergency admissions. World J Surg 2012; 36:11-16.
  3. Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis: what is the optimal timing for operation? Arch Surg 1996; 131:540-4.
  4. Serralta AS, Bueno JL, Planells MR, et al. Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. Surg Laparosc Endosc Percutan Tech 2003;13(2):71.
  5. Gelbard R, Karamanos E, Teixeira PG, et al. Effect of delaying same-admission cholecystectomy on outcomes in patients with diabetes. Br J Surg 2014;101(2):74-8.
  6. Wind J, Hofland J, Preckel B, et al. Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l'évolution des pratiques en oncologie. Can J Surg 2013;56 (5) : 297-310.
  7. Arvieux-Bartnelemy C, Mestrallet JP, Bouchard F, et al. Surgical treatment of acute cholecystitis. retrospective study of a series of 192 patients operated over a period of 3 years. Ann Chir 1999; 53 :472-81.
  8. Pessaux P, Tuech JJ, Regnet N, et al. Laparoscopic cholecystectomy in acute cholecystitis. A prospective non-randomized study. Gastroenterol Clin Biol 2000; 24: 400-3.
  9. Chandler CF, Lane JS, Ferguson P, et al. Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 2000; 66: 896-900.
  10. Shea JA, Healey MJ, Berlin JA et al. Mortality and complications associated with laparoscopic cholecystectomy. A metaanalysis. Ann Surg 1996; 224: 609-20.
  11. Eldar S, Eitan A, Bickel A, Sabo E, Cohen A, Abrahamson J, et al. The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis. Am J Surg1999; 3: 303-4.
  12. Willsher PC, Sanabria JR, Gallinger S, et al. Early laparoscopic cholecystectomy for acute cholecystitis: a safe procedure. J Gastrointest Surg 1999; 3: 50-3.
  13. Cheema S, Brannigan AE, Johnson S, et al. Timing of laparoscopic cholecystectomy in acute cholecystitis. Ir J Med Sci 2003; 172: 128-31.
  14. Wu XD, Tian X, Liu MM, Wu L, Zhao S, Zhao L. Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2015; 102:1302-13.
  15. Clavien PA, Sanabria JR, Mentha G, et al. Recent results of elective open cholecystectomy in a north american and a european center. Ann Surg 1992; 216: 618-26.
  16. Paulino-Netto A. A review of 391 selected open cholecystectomies for comparison with laparoscopic cholecystectomy. Am J Surg 1993; 166: 71-3.
  17. Gainant A, Bouvier S, Mathonnet M. Traitement chirurgical de la lithiase biliaire et de ses complications. Encyclopédie Médico-Chirurgicale (2003) 7-047-G-10.
  18. Gurusamy K, Samraj K, Gluud C, et al. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010; 97:141-50.
  19. Lai PBS, Kwong KH, Leung KL, et al. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 1998; 85:764-77.
  20. Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1998;227 (4): 461.
  21. Kolla SB, Aggarwal S, Kumar A, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 2004; 18 (9): 1323-7.
  22. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 2003; 7 (5): 642-5.
  23. Haltmeier T, Benjamin E, Inaba K, et al. Early versus delayed same-admission laparoscopic cholecystectomy for acute cholecystitis in elderly patients with comorbidities. J Trauma Acute Care Surg 2015; 78 (4): 801-7.