NEW YORK (Reuters Health) – For best results, laparoscopic cholecystectomy in patients with acute cholecystitis should be performed within 48 hours of hospital admission, a Swiss team reports.

“Delaying surgery neither reduces perioperative complications nor shortens postoperative hospital stay,” Dr. Ulrich Guller and colleagues at the University of Berne write in the August 3rd online issue of the Annals of Surgery. “On the contrary, postponing laparoscopic cholecystectomy in our study population actually results in more unfavorable outcomes compared to immediate surgery.”

They note in the introduction to their report that many surgeons in the early 2000s advocated delaying laparoscopic gallbladder surgery because increased local inflammation could obscure the surgical site and lead to complications. Even though more recent reports have favored surgery within 1 week of symptom onset, the best time-point for laparoscopic cholecystectomy is still debated.

This prompted the team to compare outcomes in 4113 patients undergoing laparoscopic cholecystectomy for acute cholecystitis at different times; 1416 underwent the procedure on the day of admission (ie, day 0), 1542 on day 1, 530 on day 2, 247 on day 3, 218 on days 4 or 5, and 160 on day 6 or later.

Rates of conversion to open surgery increased with the delay in performing laparoscopic cholecystectomy, from 11.9% on the day of admission up to 27.9% on day 6 or later, the investigators found.

Rates of postop complications increased in a similar manner (from 5.7% up to 13%), as did re-operation rates (from 0.9% up to 3%) and length of hospital stay (from 6.1 days to 8 days), according to the report.

Dr. Guller and colleagues conclude, “This study provides compelling evidence that early laparoscopic cholecystectomy should be advocated for patients admitted to hospital with acute cholecystitis.”

Reference:
Population-Based Analysis of 4113 Patients With Acute Cholecystitis: Defining the Optimal Time-Point for Laparoscopic Cholecystectomy
Ann Surg 2011.