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

TY - JOUR

T1 - Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis

AU - Hadad, Sirwan M.

AU - Vaidya, Jayant S.

AU - Baker, Lee

AU - Koh, Hoey C.

AU - Heron, Timothy P.

AU - Hussain, Kashif

AU - Thompson, Alastair M.

PY - 2007/6

Y1 - 2007/6

N2 - 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.

AB - 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.

KW - Acute Disease

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cholecystectomy

KW - Cholecystectomy, Laparoscopic

KW - Cholecystitis

KW - Disease Progression

KW - Emergencies

KW - Female

KW - Great Britain

KW - Humans

KW - Intraoperative Complications

KW - Male

KW - Middle Aged

KW - Risk Factors

KW - Treatment Outcome

U2 - 10.1007/s00268-007-9050-2

DO - 10.1007/s00268-007-9050-2

M3 - Article

C2 - 17483986

SN - 0364-2313

VL - 31

SP - 1298

EP - 1301

JO - World Journal of Surgery

JF - World Journal of Surgery

IS - 6

ER -