Laparoscopic cholecystectomy in acute cholecystitis. A prospective non-randomized study

Objectives - To evaluate the results of laparoscopic cholecystectomy in pat ients with acute cholecystitis and to determine the optimal timing. Patients and methods - From January 1993 to December 1999, 168 patients (91 women and 77 men with a mean age of 57.3 years) underwent laparoscopic cho lecystectomy for acute cholecystitis confirmed by histopathological examina tion. Patients were divided into 2 groups (similar in age and ASA classific ation) : group 1 (106 patients) underwent laparascopic cholecystectomy with in 3 days after the onset of symptoms of acute cholecystitis and group 2 (6 2 patients) underwent laparoscopic cholecystectomy after 3 days. Results-There was no death. Conversion rates were 30.9%. Surgery lasted 141 .3 min, postoperative morbidity was 12.5%, and the postoperative length of hospital stay was 6.9 days. The conversion rates in patients who underwent surgery before and 3 days after the onset of symptoms were respectively 21. 7% and 46.7% (P=0.0007). There was no statistical difference between early and delayed surgery For time to surgery and postoperative complications. On the of her hand the total hospital stay was significantly shorter in group 1. Conclusion - laparoscopic cholecystectomy for acute cholecystitis is safe a nd associated with a shorter postoperative stay, a lesser morbidity and a l esser mortality compared to "open surgery. Laparoscopic cholecystectomy sho uld be carried out soon as the diagnostic of acute cholecystitis establishe d and preferably before 3 days after the onset of the symptoms. Early lapar oscopic cholecystectomy allows a reduction of the conversion rate and a red uction of total hospital stay that are medical and economic benefits.