Safe postoperative outcomes following early cholecystectomy for acute calculus cholecystitis regardless of symptom onset
Joseph Do Woong Choi1,2
, Matthew John Fong1, Aswin Shanmugalingam1, Anoosha Aslam1, Syed Aqeel Abbas Kazmi1, Rukmini Kulkarni1, Richard James Curran1
1Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
2Discipline of Surgery, University of Sydney Faculty of Medicine and Health, New South Wales, Australia
Abstract
Objective: There is growing evidence for reduced post-operative complications, and lower hospital costs associated with early cholecystectomy for acute calculus cholecystitis (AC) compared to delayed surgery. Limited high-quality evidence exists for how early, if at all, should surgeons be operating emergently for AC based on symptom onset.
Material and Methods: Seven hundred seventy-four patients who had cholecystectomy performed by a single surgeon between January 2015-October 2022 were retrospectively reviewed. Five hundred fourty-one patients were analysed. Patients were divided into three groups based on symptom onset: Group 1: 0-72 hours (n= 305), Group 2: 72 hrs-1 week (n= 154) and Group 3: >1 week (n= 82).
Results: Median operative time was most prolonged in Group 2 (96.5 minutes), and had the greatest proportion of reconstituting 95% cholecystectomies (n= 22/154, 14.29%) compared to Group 1 (p> 0.05). The conversion to open was between 0.65-1.64% in all groups. The greatest proportion of bile leak occurred in Group 1 (n= 7/305, 2.3%) followed by Group 3 (n= 1/82, 1.22%) (p> 0.05). All were successfully managed with ERCP and biliary stent. Median hospital stay was significantly prolonged in Group 2 (2.3 days) compared to Group 1 (2 days) (p= 0.03). The proportion of 95% cholecystectomies in Group 2 and 3 were not significant compared to Group 1.
Conclusion: Early cholecystectomy for calculus cholecystitis, irrespective of the timing of symptoms appears to have safe postoperative outcomes. Surgeons do not necessarily need to limit early cholecystectomy for within 72 hours of symptom onset.
Keywords: Cholecystitis, early cholecystectomy, timing, postoperative outcomes
Cite this article as: Choi JDW, Fong MJ, Shanmugalingam A, Aslam A, Kazmi SAA, Kulkarni R, et al. Safe postoperative outcomes following early cholecystectomy for acute calculus cholecystitis regardless of symptom onset. Turk J Surg 2023; 39 (4): 321-327
This study was approved by Human Research Ethics Committee (HREC), Research Office, Western Sydney Local Health District. The study reference number is 2019/ETH02056.
Externally peer-reviewed.
Concept - JDWC, SAAK, RJC; Design - JDWC, SAAK, RJC; Supervision - RDWC, RJC; Fundings - RDWC, RJC; Materials - JDWC, MJF, AS, AA, RK Data Collection and/or Processing - JDWC, MJF, AS, AA, SAAK, RK; Analysis and/or Interpretation - JDWC, MJF, AS, AA, RK, RJC; Literature Search - JDWC, RJC; Writing Manuscript - JDWC, MJF, AS, AA, SAAK, RK; Critical Reviews - JDWC, AA, RJC.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.