Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis

Sirwan M. Hadad, Jayant S. Vaidya, Lee Baker, Hoey C. Koh, Timothy P. Heron, Kashif Hussain, Alastair M. Thompson

    Research output: Contribution to journalArticlepeer-review

    56 Citations (Scopus)

    Abstract

    Background

    Randomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate.
    Methods

    We performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis.
    Results

    Of patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0–2 days, 3–4 days, 5–6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions.
    Conclusions

    Early intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.
    Original languageEnglish
    Pages (from-to)1298-1301
    Number of pages4
    JournalWorld Journal of Surgery
    Volume31
    Issue number6
    DOIs
    Publication statusPublished - Jun 2007

    Keywords

    • Acute Disease
    • Adolescent
    • Adult
    • Aged
    • Aged, 80 and over
    • Cholecystectomy
    • Cholecystectomy, Laparoscopic
    • Cholecystitis
    • Disease Progression
    • Emergencies
    • Female
    • Great Britain
    • Humans
    • Intraoperative Complications
    • Male
    • Middle Aged
    • Risk Factors
    • Treatment Outcome

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