Delayed Presentation of Acute Cholecystitis: Comparative Outcomes of Same-Admission Versus Delayed Laparoscopic Cholecystectomy

• Published in: Journal of gastrointestinal surgery Vol. 21; no. 5; pp. 840 - 845
• Main Authors: Tan, Jarrod K. H., Goh, Joel C. I., Lim, Janice W. L., Shridhar, Iyer G., Madhavan, Krishnakumar, Kow, Alfred W. C.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-05-2017; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Body mass index; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute - surgery; Conversion to Open Surgery; Female; Gallbladder; Gallbladder diseases; Gallstones; Gastroenterology; Hospitalization; Hospitals; Humans; Laparoscopy; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Operative Time; Patients; Retrospective Studies; Surgeons; Surgery; Time Factors; Singapore; Same-admission laparoscopic cholecystectomy; Delayed laparoscopic cholecystectomy; Conversion; Acute cholecystitis; Delayed presentation
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-017-3378-1

Introduction
Studies have shown that same-admission laparoscopic cholecystectomy (SALC) is superior to delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis (AC). However, no studies have compared both modalities in patients with delayed presentation. The aim of the study was to compare outcomes between SALC and DLC in AC patients with more than 7-day symptom duration.
Methods
A retrospective analysis of 83 AC patients who underwent LC after presenting with >7 days of symptoms from June 2010 to June 2015 was performed. Patients were divided into L-SALC and L-DLC, defined as LC performed within the same admission and between 4 and 24 weeks after discharge, respectively. Peri-operative outcomes were evaluated.
Results
In L-SALC patients, the intra-operative severity was higher (
p
 < 0.001) and median operative time was longer (L-SALC, 107 min (46–220) vs L-DLC, 95 mins (25–186)) (
p =
 0.048). Conversion rates were also higher in L-SALC than that in L-DLC (L-SALC, 21.4% vs L-DLC, 4.9%) (
p
 = 0.048). While post-operative morbidity was similar, L-SALC was associated with a longer post-operative length of stay as compared to L-DLC (L-SALC, 2 (1–17) vs L-DLC, 1 (1–6)) (
p
 < 0.001).
Conclusion
DLC provides lower conversion rates and shorter length of stay in AC patients presenting beyond 7 days of symptoms. This group of patients should be offered DLC.