A delayed conversion may increase the risk of major complications in acute cholecystitis approached laparoscopically. A retrospective comparative cohort study.

AIM: Aim of this study was to evaluate whether timing of laparoscopy lasting longer than two hours before converting to open surgery can worsen the postoperative course during laparoscopic cholecystectomy (LC) for acute cholecystitis (AC). MATERIALS AND METHODS: Medical records of 1,161 patients who underwent urgent laparoscopic cholecystectomy for AC during the period 2001-2017 were retrospectively analyzed. A conversion to open surgery was performed in 70 (6%) patients. Among these, two groups of patients were identified: group 1 (n=51; 73%) included patients who underwent laparotomy within 2 hours from the beginning of the operation, and group 2 (n=19; 27%) included patients who underwent conversion to open surgery after more than 2 hours of laparoscopy. Patients were analyzed for demographic data and comorbidities. Major outcome measures were mortality, morbidity and length of stay. A p value < 0.05 was considered significant. RESULTS: Reasons for conversion to open surgery included severe inflammation (46%), visceral adhesions (27%), inability to manage common bile duct stones (17%), intolerance to pneumoperitoneum (7%) and the presence of a cholecystoduodenal fistula (1%). By comparing these groups, no significant differences were noted regarding overall morbidity (29% vs 42%, p=0.31), mortality (2% vs 5%, p=0.46) and mean postoperative length of stay (8.7 vs 8.2 days, p=0.75). Major postoperative complications (grade III-V according to Clavien and Dindo classification) were significantly more frequent in group 2 (p=0.03). CONCLUSIONS: When approaching AC laparoscopically, the decision to convert to open surgery within two hours may prevent the occurrence of major postoperative complications. Early conversion does not seem to affect the mortality and length of hospital stay. KEY WORDS: Acute Cholecystitis, Conversion, Laparoscopy.

Incidental appendectomy? Microscopy tells another story: A retrospective cohort study in patients presenting acute right lower quadrant abdominal pain.

BACKGROUND: Optimal management of macroscopically normal appendix encountered during laparoscopy for acute abdominal pain is still unclear. METHODS: 164 acute abdominal pain cases in which laparoscopy showed a normal appendix were reviewed. No other intra-peritoneal acute disease was present in 50 patients (Group 1) whereas a miscellanea of intra-peritoneal conditions was identified in the other 114 (Group 2). All the patients underwent appendectomy with specimen examination. RESULTS: Following incidental appendectomy significant microscopical changes were seen in 125 specimens (76%). Among these, inflammation was found in 122 and neuroendocrine tumors in 3. Appendices harbored pathological changes in n = 45 patients (90%) of Group 1 and in n = 34 patients (70%) of Group 2 patients (p < 0.05). Morbidity for incidental appendectomy was 2%. CONCLUSION: This study supports an appendectomy in patients who are undergoing laparoscopy for acute right lower quadrant abdominal pain even when the appendix appears normal on visual inspection.