LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS - WHAT IS THE OPTIMAL TIMING FOR OPERATION

Objective: To review the results of laparoscopic:cholecystectomy (LC) in patients with acute cholecystitis with attention to cost and clinic al outcome. Design: Retrospective study. Setting: Large private metrop olitan teaching hospital. Patients: Four hundred forty-six patients ha d LCs at our institution between January 1993 and February 1995. Acute cholecystitis, confirmed by clinical, laboratory, operative, and hist opathological findings, was present in 60 patients. Main Outcome Measu res: The medical history, laboratory findings, gallbladder ultrasounds , timing of operation from the onset of symptoms, conversion rates to open procedures, operative times, intraoperative findings, complicatio ns, postoperative length of stay, cost of operative procedures and hos pitalizations, and convalescence times were collected. Results: Laparo scopic cholecystectomy was attempted in 16 patients within 72 hours of the onset of symptoms of acute cholecystitis (group 1), in 19 patient s with symptoms between 4 and 7 days (group 2), and in 25 patients wit h symptoms lasting more than 7 days (group 3). The only factor (eg, pr eoperative laboratory and ultrasound findings) that affected the outco me of the operation was duration of symptoms prior to operation. Patie nts who had LC done within 72 hours of the onset of symptoms had lower rates of conversion to open procedures, less difficult operations, sh orter operative times, less costly procedures, and a shorter convalesc ence than those with symptoms for longer than 72 hours prior to operat ion. The conversion rates in patients operated within and after 72 hou rs were 12% and 30%, respectively. There were no bile duct injuries an d no mortalities. Conclusions: Laparoscopic cholecystectomy can be per formed safely in most patients with acute cholelithiasis. However, we found that the duration of symptoms prior to LC affected the outcome; the conversion rates, hospital costs, and convalescence times increase d in operated-on patients with symptoms for more than 72 hours. In our opinion, interval cholecystectomy may be a superior option in this la tter group of patients.