Early versus delayed laparoscopic cholecystectomy for management of acute calculus cholecystitis: our experience at King Hussein medical center

ABSTRACT

To compare early laparoscopic cholecystectomy during index admission with delayed [interval] laparoscopic cholecystectomy in the management of acute cholecystitis at King Hussein Medical Center. Over the study period of 48 months [June 2005 to May 2009], a total of 317 patients with clinical and radiographic diagnosis of acute cholecystitis were studied. One hundred-thirty one patients underwent laparoscopic cholecystectomy during the index admission [group A] while 186 patients [Group B] underwent cholecystectomy at least six weeks after the attack. Data analyzed included patients' age, gender, duration of symptoms, white blood cell count, operative time, hospital stay, overall surgical outcomes and postoperative morbidity and mortality. Both groups were demographically and clinically comparable. Surgical outcomes were comparable in group A and B with conversion rates of 8.3% and 7.4% [p = 0.6645], and complication rates of 12.25% and 12.6% [p = 0.9352] respectively. Although delayed surgery shortens operative time significantly [60 versus 100 min, p<0.0001], the overall hospital stay is significantly reduced by early operation [5 versus 14.6 days, p<0.0001]. Although both the early and delayed approaches in management of acute calculus cholecystitis are comparable in terms of complication and conversion rates, the early approach has the advantage of offering patients a definitive treatment while reducing the overall total hospital stay and avoiding the problems of failure of delayed therapy