No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study

Abstract

Background The pathological boundary of acute cholecystitis (AC) between early edematous and late chronic fibrotic inflammation beyond 72 h is well-described. Early laparoscopic cholecystectomy (ELC) is safe in AC but the timing still remains controversial. The aim of this study was to analyze the impact of the duration of symptoms on clinical severity, pathology and outcome in patients who underwent laparoscopic cholecystectomy (LC) for AC during the urgent admission.

Methods A retrospective analysis of a prospectively collected database of 61 patients who underwent LC for AC over a 6-month period was performed.

Results Of 61 patients 21 (34.43%) received ELC at <72 h and 40 (65.57%) received late LC (LLC) at >72 h. Clinically in the ELC group the majority were mild and in the LLC group the majority were moderate and severe in severity grading as per Tokyo guidelines (P<0.001). Surgical findings and histopathology showed no significant difference in the distribution of simple, phlegmonous and gangrenous cholecystitis between both groups (P=0.94). The majority were completed by a standard four port technique and only one required subtotal cholecystectomy. There was no significant difference between operating time, return to normal activities or hospital stay between both groups. There were no conversions to open cholecystectomy, no wound infections, no intra-abdominal collections, no biliary tract injury or mortality in either group.

Conclusions The degree of inflammatory change in AC is not dependent on time. LC can be safely performed in AC regardless of timing with a standardized surgical strategy in experienced units.

Keywords Acute cholecystitis, laparoscopic cholecystectomy, subtotal cholecystectomy, pathology acute cholecystitis, 72 hour boundary