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Background: Severe acute cholecystitis (AC) is a challenging disease because it comprises coexisting systemic infections that lead to vital organ dysfunction. This study evaluated the optimal surgical timing and efficacy of preoperative percutaneous cholecystostomy (PC) for patients with severe AC. Methods: Data of 142 patients who underwent cholecystectomy for severe AC between 2011 and 2021 were retrospectively collected from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology. Patients were divided into the early cholecystectomy (EC) group (within 72 h of symptom onset) and delayed cholecystectomy (DC) group. They were also subdivided into the upfront cholecystectomy group and preoperative PC before cholecystectomy group. The diagnosis and severity of AC were graded according to the Tokyo Guidelines 2018. Clinicopathological variables and outcomes were compared. Results: No significant differences in age, body mass index, American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index between the EC and DC groups were observed. Preoperative drainage was more commonly performed for the DC group than for the EC group. Local severe AC features were more commonly detected in the DC group than in the EC group. The postoperative outcomes of the EC and DC groups were comparable. Compared to the PC before cholecystectomy group, the upfront cholecystectomy group included more patients with ASA physical status ≥ 3 and more patients who used oral warfarin. Warfarin usage and cardiovascular dysfunction rates of the PC after cholecystectomy group were higher than those of the upfront cholecystectomy group. PC was associated with significantly less intraoperative bleeding and shorter hospital stays. Conclusions: Patients who can tolerate general anesthesia are good candidates for EC. Patients who use warfarin and those with cardiovascular dysfunction are considered to be at high risk for postoperative complications; therefore, to prevent AC recurrence during the waiting period, PC before cholecystectomy during the same admission is more appropriate than upfront cholecystectomy for these patients. [ABSTRACT FROM AUTHOR]

Abstract Background Severe acute cholecystitis (AC) is a challenging disease because it comprises coexisting systemic infections that lead to vital organ dysfunction. This study evaluated the optimal surgical timing and efficacy of preoperative percutaneous cholecystostomy (PC) for patients with severe AC. Methods Data of 142 patients who underwent cholecystectomy for severe AC between 2011 and 2021 were retrospectively collected from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology. Patients were divided into the early cholecystectomy (EC) group (within 72 h of symptom onset) and delayed cholecystectomy (DC) group. They were also subdivided into the upfront cholecystectomy group and preoperative PC before cholecystectomy group. The diagnosis and severity of AC were graded according to the Tokyo Guidelines 2018. Clinicopathological variables and outcomes were compared. Results No significant differences in age, body mass index, American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index between the EC and DC groups were observed. Preoperative drainage was more commonly performed for the DC group than for the EC group. Local severe AC features were more commonly detected in the DC group than in the EC group. The postoperative outcomes of the EC and DC groups were comparable. Compared to the PC before cholecystectomy group, the upfront cholecystectomy group included more patients with ASA physical status ≥ 3 and more patients who used oral warfarin. Warfarin usage and cardiovascular dysfunction rates of the PC after cholecystectomy group were higher than those of the upfront cholecystectomy group. PC was associated with significantly less intraoperative bleeding and shorter hospital stays. Conclusions Patients who can tolerate general anesthesia are good candidates for EC. Patients who use warfarin and those with cardiovascular dysfunction are considered to be at high risk for postoperative complications; therefore, to prevent AC recurrence during the waiting period, PC before cholecystectomy during the same admission is more appropriate than upfront cholecystectomy for these patients.

Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for cholelithiasis with common bile duct stones. However, the optimal timing of LC after ERCP remains controversial. This study aimed to identify the ideal time interval between ERCP and LC. Data from patients who underwent LC after ERCP between November 2016 and August 2022 were retrieved from the electronic medical information system. The patients were categorized into early cholecystectomy (within 72 h of ERCP) and delayed cholecystectomy (after 72 h). The impact of the time interval between ERCP and LC on perioperative outcomes was analyzed. A total of 197 patients were included in the study, with 45 undergoing early cholecystectomy and 152 undergoing delayed cholecystectomy. No significant differences in the preoperative characteristics or operative morbidity were observed between the groups (p = 0.286). However, a significant correlation was found between the time interval from ERCP to LC and the total length of stay (r = −350, p < 0.001). The findings suggest that early cholecystectomy after ERCP is feasible and safe, and performing LC within the first 72 h does not adversely affect postoperative outcomes. [ABSTRACT FROM AUTHOR]

BackgroundLaparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors.MethodsThis retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group.ResultsAmong 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups.ConclusionReduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings.

Abstract Introduction A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.

Purpose: To analyze if, after implementation of an evidence-based local multidisciplinary protocol for acute cholecystitis (AC), an intermediate surgical audit could improve early cholecystectomy (EC) rate and other therapeutic indicators. Methods: Longitudinal cohort study at a tertiary center. The local protocol, promoted, created, and periodically revised by the Acute Care Surgery Unit (ACSu) was updated and approved on March 2019. A specific registry was prospectively fulfilled with demographics, comorbidity, type of presentation, diagnostic items, therapeutic decision, and clinical course, considering both non-operative management (NOM) or cholecystectomy, early and delayed (EC and DC). Phase 1: April 2019–April 2021. A critical analysis and a surgical audit with the participation of all the involved Departments were then performed, especially focusing on improving global EC rate, considered primary outcome. Phase 2: May 2021–May 2023. Software SPSS 23.0 was used to compare data between phases. Results: Initial EC rate was significantly higher on Phase 2 (39.3%vs52.5%, p < 0.004), as a significantly inferior rate of patients were initially bailed out from EC to NOM because of comorbidity (14.4%vs8%, p < 0.02) and grade II with severe inflammatory signs (7%vs3%, p < 0.04). A higher percentage of patients was recovered for EC after an initial decision of NOM on Phase 2, but without reaching statistical significance (21.8%vs29.2%, n.s.). Global EC rate significantly increased between phases (52.5%vs66.3%, p < 0.002) without increasing morbidity and mortality. A significant minor percentage of elective cholecystectomies after AC episodes had to be performed on Phase 2 (14%vs6.7%, p < 0.009). Complex EC and those indicated after readmission or NOM failure were usually performed by the ACSu staff. Conclusion: To adequately follow up the implementation of a local protocol for AC healthcare, registering and periodically analyzing data allow to perform intermediate surgical audits, useful to improve therapeutic indicators, especially EC rate. AC constitutes an ideal model to work with an ACSu. [ABSTRACT FROM AUTHOR]

Percutaneous cholecystostomy (PC) is often preferred over early cholecystectomy (EC) for elderly patients presenting with acute cholecystitis (AC). However, there is a lack of solid data on this issue. Following the PRISMA guidelines, we searched the Medline and Web of Science databases for reports published before December 2022. Studies that assessed elderly patients (aged 65 years and older) with AC treated using PC, in comparison with those treated with EC, were included. Outcomes analyzed were perioperative outcomes and readmissions. The literature search yielded 3279 records, from which 7 papers (1208 patients) met the inclusion criteria. No clinical trials were identified. Patients undergoing PC comprised a higher percentage of cases with ASA III or IV status (OR 3.49, 95%CI 1.59–7.69, p = 0.009) and individuals with moderate to severe AC (OR 1.78, 95%CI 1.00–3.16, p = 0.05). No significant differences were observed in terms of mortality and morbidity. However, patients in the PC groups exhibited a higher rate of readmissions (OR 3.77, 95%CI 2.35–6.05, p < 0.001) and a greater incidence of persistent or recurrent gallstone disease (OR 12.60, 95%CI 3.09–51.38, p < 0.001). Elderly patients selected for PC, displayed greater frailty and more severe AC, but did not exhibit increased post-interventional morbidity and mortality compared to those undergoing EC. Despite their inferior life expectancy, they still presented a greater likelihood of persistent or recurrent disease compared to the control group. [ABSTRACT FROM AUTHOR]

Introduction: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods: This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes: 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion: Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome. [ABSTRACT FROM AUTHOR]

Background/Purpose: The existing risk stratification for early cholecystectomy in patients with acute cholecystitis (AC) is complex. This study aims to establish a simpler risk assessment for surgical complications after cholecystectomy based on age group. Methods: This single‐center retrospective observational study enrolled 350 patients diagnosed with AC who underwent early cholecystectomy within 72 h of diagnosis from 2013 to 2021. Patients were divided into three subgroups based on age: young (<65 years), elderly (65–79 years), and very elderly (≥80 years). Since no mortality was observed, risk factors for the Clavien‐Dindo (CD) grade ≥ II complications were identified within the entire cohort and in each subgroup. Results: There were 120 young, 130 elderly, and 100 very elderly patients. The overall prevalence of complications with CD grade ≥ II was 11.1%. Age and Tokyo Guidelines 18 (TG18) severity were independent risk factors for surgical complications in the whole cohort. Subgroup analysis revealed that there was no independent risk factor in the young group. Meanwhile, age and poor physical status were independent risk factors in the elderly group, and TG18 severity in the very elderly group. Conclusion: Evaluation of only age, physical status, and TG18 severity may be sufficient for risk stratification of surgical complications of AC. [ABSTRACT FROM AUTHOR]

Background: Cholecystitis during pregnancy poses a significant medical challenge, necessitating a careful examination of optimal management strategies. This multi-center comparative study investigates the efficacy and safety of interval cholecystectomy versus early cholecystectomy for obstetric cholecystitis, encompassing both antenatal and postpartum periods. The study focuses on women aged 22 to 35 years, aiming to provide comprehensive insights into the outcomes associated with these surgical approaches. Materials and Methods: This multi-center study involves a diverse cohort of women aged 22 to 35 years, diagnosed with obstetric cholecystitis. The participants will be recruited from Karpagam faculty of medical sciences and research, Nalan Gastro Centre and One care medical centre, Karpagam, Coimbatore, ensuring a representative sample reflecting the broader population. Patients will be randomly assigned to either the early cholecystectomy group or the interval cholecystectomy group. Baseline characteristics, including age, gestational age, and medical history, will be recorded. The primary outcome measures include surgical complications, maternal morbidity, and fetal outcomes. For antenatal cholecystitis, participants in the early cholecystectomy group will undergo surgery during pregnancy, while those in the interval cholecystectomy group will receive conservative management initially, with surgery scheduled postpartum. In the postpartum cholecystitis arm, early cholecystectomy will be performed within the first few days after delivery, while the interval cholecystectomy group will receive conservative management initially, with surgery scheduled at a later postpartum period. Data will be collected regarding the incidence of complications such as preterm labor, fetal distress, and maternal complications. Surgical outcomes, including operative time, blood loss, and postoperative recovery, will be meticulously documented. Results: Preliminary analysis reveals that both early and interval cholecystectomy demonstrates favorable outcomes in terms of maternal and fetal well-being. The early cholecystectomy group exhibits a lower incidence of acute complications during pregnancy, such as preterm labor and fetal distress, suggesting that timely surgical intervention may mitigate the progression of the disease. On the other hand, the interval cholecystectomy group demonstrates a lower overall incidence of surgical complications, emphasizing the safety of delaying surgery until after delivery. This group also shows a reduced rate of postoperative morbidity, indicating that deferring cholecystectomy does not compromise maternal health. Operative times are comparable between the two groups, dispelling concerns regarding prolonged surgery during pregnancy. Blood loss is also within acceptable limits for both cohorts. Postoperative recovery is generally uneventful, with no significant differences observed in terms of hospital stay and time to return to normal activities. Conclusion: In conclusion the findings suggest that early cholecystectomy may be particularly beneficial in reducing acute complications during pregnancy, providing a timely resolution to the inflammatory process. On the other hand, interval cholecystectomy appears to be a safe alternative, avoiding surgery during pregnancy and demonstrating favorable postoperative outcomes. [ABSTRACT FROM AUTHOR]

This article discusses a study that examined the safety and outcomes of early cholecystectomy for acute calculous cholecystitis, regardless of the timing of symptoms. The study included 541 patients who underwent cholecystectomy and found that early cholecystectomy had safe postoperative outcomes, with no significant difference in outcomes based on the timing of symptoms. Bile duct injury and bile leak were successfully managed with ERCP and stent. Male patients were found to be at higher risk for severe cholecystitis. Overall, early cholecystectomy was found to be safe and effective for acute calculous cholecystitis. Further research is needed to explore outcomes and compare different surgical approaches. [Extracted from the article]

Aim: To determine the preferred method of treatment in patients with choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP) by evaluating efficacy of early laparascopic cholecystectomy compared to delayed laparoscopic cholecystectomy. Method: Literature searching was carried out on two databases, PubMed and Cochrane, according to the inclusion and exclusion criteria. Two randomized clinical trial (RCT) studies were appraised critically for validity, importance, and applicability. Results: Early laparascopic cholecystectomy after ERCP shows lower outcomes in incidence of recurrent choledocholithiasis, acute cholecystitis, duration of hospitalization, and treatment costs (p 0.05). Meanwhile, there was no significant difference (p 0.05) between the two groups regarding the incidence of biliary adhesions, bleeding during cholecystectomy, and laboratory parameters such as total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT). Conclusion: Early cholecystectomy, within three days after ERCP, is recommended for the treatment of choledocholithiasis after ERCP removal.

Background: The study aims to evaluate and compare the clinical outcomes of early and delayed laparoscopic cholecystectomy in patients with acute cholecystitis. Material and Methods: Thirty patients, with acute cholecystitis, who had undergone laparoscopic cholecystectomy were studied. The patients were deemed to have undergone early laparoscopic cholecystectomy if they had their surgery within 72 hours of the initial presentation of the symptoms. All those patients, who underwent the surgery after 4 weeks, were considered to be in the delayed laparoscopic cholecystectomy group. Results: The early and delayed groups had 19 and 11 patients respectively. The overall occurrence of intraoperative complications was found to be similar in both groups. It was 84.2% in the early laparoscopic cholecystectomy group, and in comparison, it was 90.9% in the delayed group. Major bleeding in the early group was 21.1% and that of the delayed group was 18.2%. The bile and gallstone spillage, in our study, among the early and delayed groups were 47.4% and 72.7% respectively. In our study, the drain requirement in the delayed group was 63.6%, while it was 52.6%, in the early group. The duration of surgery on average was 140.5 minutes in the early group when compared to 95.5 minutes in the delayed group. Conclusion: There were no statistically significant differences in the outcomes of early and delayed laparoscopic cholecystectomy in patients with acute cholecystitis regarding complications. Duration of surgery was more and length of hospital stay less in early group. [ABSTRACT FROM AUTHOR]

Aim: To determine the preferred method of treatment in patients with choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP) by evaluating efficacy of early laparascopic cholecystectomy compared to delayed laparoscopic cholecystectomy. Method: Literature searching was carried out on two databases, PubMed and Cochrane, according to the inclusion and exclusion criteria. Two randomized clinical trial (RCT) studies were appraised critically for validity, importance, and applicability. Results: Early laparascopic cholecystectomy after ERCP shows lower outcomes in incidence of recurrent choledocholithiasis, acute cholecystitis, duration of hospitalization, and treatment costs (p < 0.05). Meanwhile, there was no significant difference (p > 0.05) between the two groups regarding the incidence of biliary adhesions, bleeding during cholecystectomy, and laboratory parameters such as total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT). Conclusion: Early cholecystectomy, within three days after ERCP, is recommended for the treatment of choledocholithiasis after ERCP removal. [ABSTRACT FROM AUTHOR]

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Background: Comparative evaluation of the efficacy of Interval Cholecystectomy and Early Cholecystectomy Among Patients of Acute Cholecystitis. Materials & methods: A total of 100 patients with presence of acute cholecystitis were analysed. All the patients were broadly and randomly divided into two study groups as follows: Group A: 50 patients who were schedule to undergo interval cholecystectomy, andGroup B: 50 patients who were schedule to undergo early cholecystectomyComplete history of all the patients was obtained. All patients were subjected to detailed history including, chief complaints, history of present and past illness, personal history, family history, treatment and drug history. All the operative procedures were carried out under the hands of skilled and experienced surgeons. Follow-up was done and complications (if any) were recorded separately. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. Results: Occurrence of postoperative wound infection and biliary leaks was higher among the patients of group B in comparison to patients of group A.Mean hospital stay among the patients of group A and group B was 5.6 days and 9.1 days respectively. While comparing statistically, significant results were obtained. Conclusion: Interval Cholecystectomy shows better results in comparison to Early Cholecystectomy among patients of Acute Cholecystitis in terms of occurrence of postoperative complications and shorter duration of hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: This systematic review and meta-analysis aimed to evaluate early versus late cholecystectomy outcomes after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy as per the literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours of cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, or biliary tract complications in the less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between the less than 2 weeks and more than 2 weeks groups. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), and bile duct injury (risk ratio 0.62, p=0.01) was significantly less earlier than the 4-week group. Hospital stay was not significantly different between the less than 4 weeks versus the more than 4 weeks group. (Mean difference= -2.74, p=0.12). Overall complication rates were significantly more in the less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in the less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors., Methods: This retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group., Results: Among 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups., Conclusion: Reduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Raja, Ali, Kumar, Raja, Samo and Memon.)

Objective: Acute pancreatitis is a nonbacterial inflammation that occurs as a result of the pancreatic gland being released into the interstitial area with the activation of its own enzymes and digesting its own tissue. Gallstones are the most common cause of acute pancreatitis. Cholecystectomy is the gold standard in the treatment of acute biliary pancreatitis (ABP) to prevent complications and recurrences. The timing of cholecystectomy is still controversial. In this study, we aimed to compare the early and late results of patients who were hospitalized in our clinic with the diagnosis of mild and moderate ABP and underwent laparoscopic cholecystectomy (LC). Methods: The files of 45 patients who were hospitalized with the diagnosis of ABP and underwent LC were reviewed retrospectively. Of the patients, 35 (77.8%) were females and 10 (22.2%) were males. Twenty-two patients who underwent LC after completion of ABP treatment were named Group 1, and patients who were given a 2-month interval after ABP treatment and underwent LC afterward were named Group 2. Results: There were 22 patients in Group 1 and 23 patients in Group 2, It consisted of a total of 45 patients. The average age of the patients was 56 (26–93) years. The average hospital length of stay was 13.18 days in Group 1 and 8.3 days in Group 2. The mean duration of LC was 57.8 min in Group 1 patients, 45.7 min in Group 2, and a significant difference was found (p<0.01). Postoperative complications were seen in 4 (18.2%) patients in Group 1 and 4 (17.4%) patients in Group 2. Acute pancreatitis was seen again in 1 (4.5%) patient in Group 1 and 2 (8.7%) patients in Group 2. Conclusion: In the treatment of ABP, although the duration of LC performed in the early period was prolonged, there was no difference in postoperative hospital stay and complications. We believe that early LC should be performed to prevent recurrences and complications that may develop after ABP attacks. [ABSTRACT FROM AUTHOR]

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

Background: In patients with biliary colic, high-quality prospective data supporting the precise timing of cholecystectomy are lacking. The purpose of this study was to determine the effectiveness of early laparoscopic cholecystectomy in children with biliary colic. Methods: A multicenter, parallel-group, randomized study was conducted in patients with biliary colic at 5 hospitals in China. Pediatric patients with biliary colic were prospectively randomized to either the early cholecystectomy or conservative management strategy. The clinical outcomes within 6 months, including the number of biliary colic-free patients and gallstone-related complications, were compared (register number ChiCTR1900021830). Results: During the first 2 months of follow-up, 71 patients (59.2%, 71/120) receiving conservative management and 124 patients (97.6%, 124/127) in the early cholecystectomy group (p < 0.001) reported being entirely colic-free. The GIQLI measures were higher in the early cholecystectomy group than in the conservative management group (p = 0.032). Acute readmissions occurred in 7 (5.5%) of 127 patients in the early cholecystectomy group, compared with 23 (19.2%) of 120 patients in the conservative management group (risk ratio [RR] 0.25; 95% CI [0.10–0.60], p = 0.001) in the 6-month period. Conclusions: Early cholecystectomy is effective in providing beneficial outcomes in terms of both short-term and long-term improvement of symptoms. [ABSTRACT FROM AUTHOR]

Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.

Background/purpose: The existing risk stratification for early cholecystectomy in patients with acute cholecystitis (AC) is complex. This study aims to establish a simpler risk assessment for surgical complications after cholecystectomy based on age group., Methods: This single-center retrospective observational study enrolled 350 patients diagnosed with AC who underwent early cholecystectomy within 72 h of diagnosis from 2013 to 2021. Patients were divided into three subgroups based on age: young (<65 years), elderly (65-79 years), and very elderly (≥80 years). Since no mortality was observed, risk factors for the Clavien-Dindo (CD) grade ≥ II complications were identified within the entire cohort and in each subgroup., Results: There were 120 young, 130 elderly, and 100 very elderly patients. The overall prevalence of complications with CD grade ≥ II was 11.1%. Age and Tokyo Guidelines 18 (TG18) severity were independent risk factors for surgical complications in the whole cohort. Subgroup analysis revealed that there was no independent risk factor in the young group. Meanwhile, age and poor physical status were independent risk factors in the elderly group, and TG18 severity in the very elderly group., Conclusion: Evaluation of only age, physical status, and TG18 severity may be sufficient for risk stratification of surgical complications of AC., (© 2023 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

Background: Acute cholecystitis (AC) after cardiovascular surgery (CS) tends to have a serious postoperative course; however, there are few reports of AC after CS. In this study, we investigated the clinical features of AC after CS. Method: Of 26 patients who underwent surgery for AC after CS between 2001 and 2018 were investigated. Of these patients, the severity of AC, onset time, surgical outcomes, and postoperative pathological findings were evaluated. Results: Grade III accounted for 46% (12/26) of the AC after CS patients. Gallbladder drainage did not produce sufficient outcomes in all CS cases. The postoperative hospital days of AC after CS were extended (31/21 days, P = 0.07) and the postoperative pathologic findings revealed a higher rate of gangrenous cholecystitis (88/41%, P < 0.01) than the control group. With regard to the incidence of postoperative complications, there were no differences between CS and the control group (23/24%). The mortality rate of AC after CS was 12%. Conclusion: Because more than 80% of CS cases involved pathologically gangrenous cholecystitis, it may be necessary to perform early surgery for AC after CS, even when the severity of AC is Grade III. [ABSTRACT FROM AUTHOR]

Background: For decades, the optimal timing of surgery for acute cholecystitis has been controversial. Recent meta-analyses and population-based studies favor early surgery. One recent large randomized trial has demonstrated that a delayed approach increases morbidity and cost compared to early surgery within 24 hours of hospital admission. Since cases of severe cholecystitis were excluded from this trial, we argue that these results do not reflect real-world clinical situations. From our point of view, these results were in contrast to the clinical experience with our patients; so, we decided to analyze critically all our patients with the null hypothesis that the patients treated with a delayed cholecystectomy after an acute cholecystitis have a similar or even better outcome than those treated with an early operative approach.Patients and methods: We retrospectively analyzed clinical data from all patients with cholecystectomies in the period between January 2006 and September 2015. A total of 1,723 patients were categorized into four groups: early (n=138): urgent surgery of patients with acute cholecystitis within the first 72 hours of the onset of symptoms; intermediate (n=297): surgery of patients with acute cholecystitis within an average of 10 days after the onset of symptoms; delayed (n=427): initial non-surgical treatment of acute cholecystitis with surgery performed within 6–12 weeks of the onset of symptoms; and elective (n=868): cholecystectomy within a symptom-free interval of choice in patients with symptomatic cholecystolithiasis without signs of acute cholecystitis.Results: In a real-world scenario, early/intermediate cholecystectomy in acute cholecystitis was associated with a significant increase in morbidity and mortality (Clavien–Dindo score) compared to a delayed approach with surgery performed 6–12 weeks after the onset of symptoms. The adjusted linear rank statistics showed a decrease in the complication score with values of 2.29 in the early group, 0.48 in the intermediate group, –0.26 in the delayed group and –2.12 in the elective group. The results translate into a continuous decrease of the complication score from early over intermediate and delayed to the elective group.Conclusion: These results demonstrate that delayed cholecystectomy can be performed safely. In cases with severe cholecystitis, early and/or intermediate approaches still have a relatively high risk of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Highlights • A rapid imaging protocol with defined clinical criteria for acute cholecystitis (AC) resulted in significant improvements in perioperative and quality measures. • Acute on chronic cholecystitis (ACC) may present with typical and/or atypical clinical features of AC, and was the most common pathology found in our specimens for the RIP. • HIDA and CT scan had similar performance for de novo AC. However, diagnostic performance for both studies was reduced in the setting of ACC. • Delayed filling of the gallbladder on HIDA in a patient with high risk features is ACC until proven otherwise, and urgent cholecystectomy should be considered. Abstract Introduction In this study we assess the impact of a "rapid imaging protocol" (RIP) on outcomes in patients with suspected acute cholecystitis (AC). Methods From January 2017 to January 2018, a prospective cohort study was implemented using a RIP with hepatoscintigraphy (HIDA) or CT scan (first available, goal within 4 h) in patients (n = 52) presenting with highly suspected AC and a clinical feature score of ≥1. For the latter, the following presenting features were scored as follows: 1 point for WBC count ≥10,000 (109/L), 1.5 points for glucose ≥140 (mg/dl), and/or 1 point for age ≥50 yrs. The historical control was all patients admitted with suspected AC in a 1.5-year period (n = 117) under our previous "delayed imaging protocol" (DIP), which used US ± HIDA (post-admission) in select patients. Primary end points included: compare outcome and quality measures between the groups, evaluate diagnostic imaging performance for AC, and evaluate our proposed clinical feature score in the setting of AC. Results Histopathologic features consistent with AC was more frequent in patients in the RIP (64% vs 39%, p = 0.008). The pooled positive predictive value of HIDA and CT scan for AC were 85% vs 94%, respectively. The RIP was associated with a significant reduction in time to surgery, length of stay, and conversions to open (p < 0.001, respectively). A clinical feature score of 3.5 predicted the likelihood of AC in 95% of the cases (x2 for linear trend = 42, p < 0.001). Conclusion A protocol centered around rapid identification, defined clinical criteria (i.e. clinical feature score), and confirmation with non-user dependent imaging modalities has resulted in favorable outcomes. CT may be the study of choice when the likelihood of AC is high because it is superior at identifying severity. [ABSTRACT FROM AUTHOR]

Background: While evidence supports early compared to delayed cholecystectomy as optimal management of acute calculous cholecystitis (ACC), significant variability in practice remains. The purpose of this study was to identify variables associated with early cholecystectomy, to target opportunities to improve adherence to best practices.Methods: Adult patients admitted to surgical units with ACC at two hospitals in a university hospital network between June 2010 and January 2015 were reviewed. Patients with concurrent pancreatitis, cholangitis or severe ACC (with organ system failure) were excluded. Early cholecystectomy was defined as surgery performed during same admission and within 7 days of presentation. Non-operative management was defined as admission for ACC treated conservatively, with or without eventual delayed cholecystectomy. The primary outcome was early cholecystectomy versus initial non-operative management; secondary outcomes included time to cholecystectomy, complications, and total hospital length of stay (LOS).Results: A total of 374 patients were included. Two hundred and forty six patients (66%) underwent early cholecystectomy, 60 (16%) were treated non-operatively and had delayed cholecystectomy, and 68 (18%) were only treated non-operatively. Median time to OR from initial presentation was 38 h [22-63] for early cholecystectomy patients and 69 days [29-116] for the non-operative patients who had delayed cholecystectomy. When comparing both groups, early cholecystectomy patients were younger and were treated more often at site 1. There were no differences in complications during hospitalization, but early cholecystectomy patients had a lower median total LOS (3 [2-5] vs. 5 [4-9], p < 0.001), and they had fewer gallstone-related events after discharge (1 vs. 18%, p < 0.001). On multiple logistic regression analysis, lower age, hospital site and lower risk of concurrent choledocholithiasis were all significantly associated with early cholecystectomy (p < 0.05).Conclusion: Our data supports early cholecystectomy as best practice in management of ACC with no differences in complications during hospitalization, shorter median LOS and fewer gallstone-related events compared to non-operative management. We identified patient and institutional factors associated with early cholecystectomy. This suggests that multiple strategies will be necessary to promote adherence to best practices in the management of ACC within our institution. [ABSTRACT FROM AUTHOR]

Summary Background Recent advances in laparoscopic techniques and perioperative care have changed the indications for surgery in elderly patients. Consequently, the willingness to offer early surgery for acute cholecystitis continues to increase. This study aims to assess the perioperative outcome of early cholecystectomy for acute calculous cholecystitis in elderly patients. Patients and methods All consecutive patients treated by early cholecystectomy for acute calculous cholecystitis in a major teaching hospital, between January 2002 and November 2016, were retrospectively analyzed. The outcome of elderly patients (≥ 75 years) was compared to that of all others. Conversion rate, 30 days morbidity, 30 days mortality and length of hospital stay were assessed. Results Early cholecystectomy for acute calculous cholecystitis was performed in 703 patients: 121 (17%) aged ≥ 75 years and 582 (83%) aged < 75 years. Significantly more elderly patients had an ASA score ≥ 3 (37% vs. 8%, P < 0.001). Morbidity was higher in the elderly group (17% vs. 8%, P < 0.004), mainly attributable to the high incidence of cystic stump leakage in this group; a complication that no longer occurred after changing the technique of ligation of the cystic stump. The cardiopulmonary complication rate (4% vs. 3%, P = 0.35) as well as mortality did not significantly differ (3% vs. 1%, P = 0.07). The conversion rate was higher in the elderly group (18% vs. 5%, P < 0.001) and the median postoperative length of hospital stay was longer (5.0 vs. 3.0 days, P < 0.001). Conclusion Early laparoscopic cholecystectomy is a treatment well suited to elderly patients with mild and moderate acute cholecystitis. [ABSTRACT FROM AUTHOR]

Purposes: The purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis. Methods: Data were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group ( n = 10) and a non-comorbidity group ( n = 83). Results: There were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate ( P = 0.629), conversion rate ( P = 0.114), or intraoperative blood loss ( P = 0.147) between the comorbidity and non-comorbidity groups. Conclusion: Our findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery. [ABSTRACT FROM AUTHOR]

Background: In the era of advanced surgical techniques and improved perioperative care, the willingness to perform emergency operations in elderly patients continues to increase. This systematic review aimed at assessing the clinical outcomes of early cholecystectomy in elderly patients with acute cholecystitis. Methods: Medline, Embase, and Cochrane Library databases were systematically searched for studies reporting on early cholecystectomy for acute cholecystitis in patients aged = 70 years. The conversion rate, perioperative morbidity, and mortality were calculated using a random-effects model. Results: Eight articles fell within the scope of this study. In total, 592 patients were identified. The mean age was 81 years. Early cholecystectomy was performed laparoscopically in 316 patients (53%) and open in 276 patients (47%). The procedure was associated with a conversion rate of 23% (95% CI 18.6-28.3), a perioperative morbidity of 24% (95% CI 20.5-27.5), and a mortality of 3.5% (95% CI 2.3-5.4). Conclusion: Early cholecystectomy seems to be a feasible treatment in elderly patients with acute cholecystitis. To reduce morbidity, patients who may benefit from surgery ought to be selected carefully. Future prospective studies should compare early cholecystectomy with alternative treatments to select the treatment that is most appropriate for elderly patients. [ABSTRACT FROM AUTHOR]

Objective: The timing of early cholecystectomy in acute cholecystitis is still controversial, and data regarding the use of Tokyo 2013 guideline for diagnosis and severity grading in Acute Cholecystitis is limited. The aim of this study was to evaluate the clinical and pathologic outcomes of early cholecystectomy after 72 hr and within seven days of index admission according to Tokyo 2013 guideline for diagnosis and severity grading of Acute cholecystitis (in patients with Acute cholecystitis. Material and Methods: Medical charts of 172 patients who underwent early cholecystectomy after 72 hr and within 7 days of index admission with a diagnosis of Acute cholecystitis between Aug 2009 and Apr 2014 were retrospectively analyzed. Patients were classified according Tokyo 2013 guideline criteria. Results: The median age of the study group was 52 yr. The rates of open and laparoscopic cholecystectomies was 53.5% and 33.1%, respectively. Conversion to open cholecystectomy was performed in 19 patients (13.4%). The median length of hospital stay was 7 days. Eighty-four patients (59.2%) met the criteria for a definite diagnosis of Acute cholecystitis according to Tokyo 2013 guideline. Longer postoperative and total length of hospital stay was determined in patients with a definite diagnosis. Conclusion: Increased severity grading is correlated with longer pre- and post-operative hospital stay. Early cholecystectomy in Acute cholecystitis performed by experienced surgeons after 72 hr of admission and within 7 days maybe a feasible and safe procedure. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare early and delayed cholecystectomy for the treatment of acute calculous cholecystitis (ACC). Materials and methods: The medical records of patients who were diagnosed to have ACC by combined clinical and radiological examination were evaluated retrospectively. The patients were divided into two non-randomized groups according to the duration between the onset of symptoms and cholecystectomy. Group 1 included the patients who underwent cholecystectomy within the first 72 h after the onset of symptoms and Group 2 those who underwent beyond the 72nd hour after the onset of symptoms. Results: We reviewed records for 203 patients. There were 109 patients in Group 1 and 74 patients in Group 2. Access-related complications occurred in four patients. One patient in Group 1 and two patients in Group 2 had trocar site bleeding. In one patient in Group 1, liver trauma occurred. Two patients had bile duct injury in Group 1 as Type D injury according to the Strasberg classification in one patient and E2 injury in other. Conclusion: Early cholecystectomy in acute cholecystitis with biliary stones could be performed regardless of time with similar complication, mortality and conversion rates. [ABSTRACT FROM AUTHOR]

Question: What are the clinical outcomes of early versus delayed laparoscopic cholecystectomy (LC) in acute cholecystitis with more than 72 hours of symptoms? Design: A randomized controlled trial. Setting: Single center at the University Hospital of Lausanne, Switzerland. Patients: Eighty-six patients were enrolled in the study that had symptoms of acute cholecystitis lasting more than 72 hours before admission. Intervention: Patients were randomly assigned to early LC or delayed LC. Main Outcome: Primary outcome was overall morbidity following initial diagnosis. Secondary outcomes included total length of stay, duration of antibiotic used, cost, and surgical outcome. Results: Overall morbidity was lower in early laparoscopic cholecystectomy (ELC) [6 (14%) vs 17 (39%) patients, P = 0.015]. Median total length of stay (4 vs 7 days, P < 0.001) and duration of antibiotic therapy (2 vs 10 days, P < 0.001) were shorter in the ELC group. Total hospital costs were lower in ELC (9349€ vs 12,361€, P = 0.018). Operative time and postoperative complications were similar (91 vs 88 minutes; P = 0.910) and (15% vs 17%; P = 1.000), respectively. Conclusions: ELC for acute cholecystitis even beyond 72 hours of symptoms is safe and associated with less overall morbidity, shorter total hospital stay, and duration of antibiotic therapy, as well as reduced cost compared with delayed cholecystectomy. [ABSTRACT FROM AUTHOR]

Objectives: A comparative, prospective study was conducted to compare the results of early and delayed laparoscopic cholecystectomy in tertiary care centre of Al-Madinah Al-Munawara region in terms of hospital stay, cost effectiveness, complications, conversion to open cholecystectomy, patient compliance, morbidity and mortality. Materials and Methods: Study was conducted in Surgical Unit, King Fahad Hospital from February 2014 to January 2016. 100 patients were part of this study. Group A, 50 patients presented in surgical emergency with first att ack of acute cholecystitis. Group B, 50 patients with more than one episodes of acute cholecystitis and admitt ed through out-patient department. Patients unfit for laparoscopic surgery, previous abdominal surgery, with acute pancreatitis, acute cholangitis, jaundice and stones in common bile duct were excluded from this study. Results:Among Group A, 50 patients underwent early laparoscopic cholecystectomy;mean hospital stay was 4.48 days, cost for single patient S.R. 5016, 3 patients (6%) were converted to open cholecystectomy, 5 patients (10%) had bile leak during procedure, 2 patient (4%) have additional ERCP with slipped stone in common bile duct and all patients recovered with no significant morbidity and mortality. Among group B, 50 patients; mean hospital stay was 6.72 days, cost for single patient S.R. 6024, 1 patient (2%) converted to open cholecystectomy, 2 patients(4%) with bile leakage, with no significant morbidity and mortality. Conclusion:Early laparoscopic cholecystectomy has advantage of less hospital stay and cost benefits but greater conversion rate to open cholecystectomy and higher complication rate with no significant difference in morbidity and no mortality. [ABSTRACT FROM AUTHOR]

Background: Acute cholecystitis occurs in approximately 1 % of patients with known gallstones. It presents as a surgical emergency and usually requires hospitalisation for treatment. It is associated with significant morbidity and mortality, particularly in the elderly. Cholecystectomy is advocated for acute cholecystitis; however, the timing of cholecystectomy and the value of the additional treatments have been a matter of debate. This review examines the available evidence regarding the optimal surgical management of patients with acute cholecystitis. Methods: A literature search was performed on the MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform, databases for English language publications. The MeSH headings 'cholecystitis', 'acute', 'gallbladder', 'inflammation', 'surgery', 'cholecystectomy', 'laparoscopic', 'robotic', 'telerobotic' and 'computer-assisted' were used. Results: Data from eight randomised controlled trails and three population-based analyses show that early cholecystectomy for acute cholecystitis performed on the index admission is safe and not associated with increased conversion rates or morbidity in comparison to conservative treatment followed by elective cholecystectomy. Delaying cholecystectomy increases readmissions for gallstone-related events, complications, hospital stay and mortality in the elderly. Early cholecystectomy is also more cost-effective. Randomised trials addressing antibiotic use in acute cholecystitis suggest that antibiotics should be stopped on the day of cholecystectomy. Insufficient trials have been performed to address the optimal analgesia regime post cholecystectomy. Similarly, a lack of trials on intraoperative cholangiography and management of common bile duct stones in patients with acute cholecystitis means that treatment of concomitant bile duct stones should be based on institutional expertise and resource availability. As regards acute cholecystitis in elderly and high-risk patients, case series and retrospective studies would suggest that cholecystectomy is more effective and of lower mortality than percutaneous cholecystostomy. There is not enough evidence to support the routine use of robotic surgery, single-incision laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery (NOTES) in the treatment of acute cholecystitis. Conclusions: Trial evidence would favour a policy of early laparoscopic cholecystectomy following admission with acute cholecystitis. The optimal approach to support early cholecystectomy is suggested but requires evidence from further randomised trials. [ABSTRACT FROM AUTHOR]

Introduction: The timing of laparoscopic cholecystectomy for acute cholecystitis remains an issue for debate amongst general surgeons. The aim of this study was to compare clinical outcomes between early and delayed cholecystectomy for acute cholecystitis. The primary outcome measures included mortality rates, complication rates, length of hospital stay and conversion rates to open procedures. Materials and Methods: A search of electronic databases was performed for randomised controlled trials. Fifteen studies were included. Results: Early surgery has a decreased risk of wound infections (RR 0.57, 95 % CI 0.35-0.93, p = 0.01) compared with delayed surgery but no difference in mortality, bile duct injuries, bile duct leaks and the risk of conversion to open surgery. Of patients in the delayed group, 9.7 % failed initial non-operative management and underwent emergency LC. Early surgery had a significantly reduced total hospital stay and mean hospital costs compared with delayed surgery. Conclusion: Early laparoscopic cholecystectomy in acute cholecystitis demonstrated decreased incidence of wound infections, a shorter total length of stay and decreased costs with no difference in the rates of mortality, bile duct injuries, bile leaks and conversions. These results support that early laparoscopic cholecystectomy is the best care and should be considered a routine in patients presenting with acute cholecystitis. [ABSTRACT FROM AUTHOR]

Background Single-incision laparoscopic cholecystectomy (SILC) has become increasingly popular but its role in acute cholecystitis remains controversial. Methods We compared the clinical features and outcomes of SILC procedures between 52 patients with acute cholecystitis (the AC group) and 308 patients without acute cholecystitis (the NAC group). We also analyzed clinical variables to identify factors affecting difficulties associated with SILC for acute cholecystitis. Results The patients in the AC group were significantly older than those in the NAC group (72 vs. 61 years, median, P = 0.0005). The preoperative levels of white blood cell counts were significantly higher in the AC group than in the NAC group (6600 vs. 5500/μL, P = 0.0004). The operative time was significantly longer in the AC group than in the NAC group (188 vs. 135 min, P < 0.0001). The volume of intraoperative blood loss was significantly larger in the AC group than in the NAC group (20 vs. 5 mL, P < 0.001). Furthermore, additional trocar insertion was required in 12% in the NAC group, whereas it was required in 60% in the AC group (P < 0.0001). Regarding the difficulties of SILC for acute cholecystitis, delayed operation (after 72 h from the onset) was significantly associated with a prolonged operative time, while a higher grade of acute cholecystitis (grade II or III) was significantly associated with an increased blood loss during surgery. Conclusions These findings suggest that when compared to SILC for gallbladder diseases without acute inflammation, SILC for acute cholecystitis was associated with a longer operative time, increased blood loss, higher rate of additional trocar requirement, higher rate of postoperative complications, and longer hospital stay. The difficulties associated with SILC for acute cholecystitis were affected by the timing of surgery and the grade of inflammation. [ABSTRACT FROM AUTHOR]

Introduction Early cholecystectomy within 72 hours has been shown to be superior to late or delayed cholecystectomy with regard to outcome and cost of treatment. Recently, immediate cholecystectomy within 24 hours of onset of symptom was proposed as standard procedure for the management of fit patients presenting with acute cholecystitis. We sort to find out if there are any differences in surgical outcomes between patients managed within 24 h and those managed 25-72 h following symptom begin for acute cholecystitis Patients and methods A retrospective analysis was performed. The outcomes of patients undergoing laparoscopic cholecystectomy within 24 h were compared to those of patients managed 25-72 h following symptom onset for acute cholecystitis. Results 35 patients managed 25-72 h following begin of symptoms were matched with 35 patients with similar baseline features, medical comorbidities and disease severity managed within 24 hours of symptom onset. There were no significant differences in the duration of surgery, postoperative complications, rate of conversion and length of hospital stay Conclusion Immediate laparoscopic cholecystectomy for acute cholecystitis within 24 hour of symptom onset is not superior to surgery 25-72 hour after symptoms begin. Laparoscopic cholecystectomy for acute cholecystitis therefore can be safely performed anytime within the golden 72 h. [ABSTRACT FROM AUTHOR]

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Background: The aims of this study were to describe the surgical management of acute cholecystitis (AC) in a well-defined population-based patient cohort, in particular adherence to and outcome of the early open/laparoscopic cholecystectomy (EC/ELC) strategy. Methods: The medical records of all patients residing in Stockholm County who were treated for AC during 2003 and 2008 were reviewed according to a standardized protocol. Results: In 2003, 799 patients were admitted 850 times for AC, and the respective figures for 2008 were 833 and 919. The number of patients who underwent EC/ELC increased from 42.9% in 2003 to 47.4% in 2008. In multivariate regression analysis adjusting for age, gender, severity of cholecystitis, maximal CRP and maximal WBC, EC/ELC was associated with shorter operation time but higher perioperative blood loss when compared to delayed open/laparoscopic cholecystectomy (DC/DLC). The odds ratio for completing the procedure laparoscopically was significantly higher in DC/DLC when adjusting for the same covariates. There were no significant differences in peri- or postoperative complications between the groups. Conclusion: Strategies should be implemented in order to secure a more evidence-based approach to the surgical treatment of AC. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]