RESUMO
Several randomized studies in the early 1980s have shown that performing early cholecystectomy for acute cholecystitis was better than delayed cholecystectomy in terms of operative feasibility, post-operative complications and shorter hospital stay. In the era of minimal access surgery, laparoscopic cholecystectomy is widely established as the standard in acute cholecystitis. However, in the presence of acute inflammation, higher conversion rates of up to 30 % have been reported. Several studies have reported favourable outcomes with a low conversion rate if patients are operated within 96 hours of admission. In this study we compare the safety, intra-operative difficulty, post-operative morbidity, duration of stay in hospital, and effectiveness of early lap- / open-, versus delayed (late) lap- / open- cholecystectomy in acute cholecystitis. MethodsThis is a prospective study conducted in the Department of General Surgery, Government Stanley Medical College, from October 2016 to August 2017. From cases attending our institute for treatment of acute cholecystitis, 25 patients with acute cholecystitis were subjected to early lap- /open- cholecystectomy within 7 days of onset of symptoms and another 25 patients were subjected to late cholecystectomy at least 6 weeks after symptoms have subsided. ResultsThe two groups were well matched in terms of age, sex as well as clinical and laboratory parameters. Both early and late groups were compared both in terms of intraoperative and post-operative complications. Among the early group, 17 [68%] underwent laparoscopic cholecystectomy and 8 [32%] underwent open cholecystectomy. In the late group 19 [76%] underwent laparoscopic cholecystectomy and 6 [24%] underwent open cholecystectomy. Taking bile duct injury in to account 3 patients [12%] among the early group and 6 patients in DC [24%] had bile duct injury. 4 patients [16 %] in the early group and 6 patients [24%] in the late group had wound infections. In the early group, 6 patients [24%] and 10 patients [40%] in the late group had lung infections. Duration of stay in early cholecystectomy group was shorter when compared to patients who underwent late cholecystectomy. ConclusionsEarly cholecystectomy is safe in terms of dissection of Calot’s triangle and bile duct injury. The duration of surgery, the rate of wound infection, and the hospital stay, are however significantly shorter than the delayed cholecystectomy and reduces the rate of medical treatment failure and biliary peritonitis.