Early Laparoscopic Cholecystectomy for Acute Cholecystitis: a New Standard of Definite Treatment

High complications and conversion rate associated with laparoscopic treatment for acute cholecystitis was a common sense by surgeons. The optimal time of laparoscopic cholecystectomy for acute cholecystitis remains controversial. Either early or interval elective to undergo laparoscopic cholecystectomy for acute cholecystitis could gain the best cost/beneficial ratio. A prospective randomized study was performed to make it clear. During a 29-month period, 97 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n= 48) or delayed interval surgery after initial medical treatment (delayed group, n=49). Thirteen patients (five in the early group and eight in the delayed group) were excluded because of refusal of operation (n=5), misdiagnosis (n=5), contraindication for laparoscopic surgery (ca. of gallbladder), or loss of follow-up (n=2). Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n=3) and persistent fever (n=5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs.11%; p=0.174) and complication rate (29% vs.13%; p=0.07). For 38 patients with symptoms exceeding 72 hours before admission, the conversion rate remained high after delayed surgery (30% vs. 17%; p=0.454). In addition, delayed laparoscopic cholecystectomy prolonged the total hospital stay (11 days vs. 6 days; p＜0.001) and recuperation period (19 days vs.12 days; p＜0.001).We concluded that initial conservative treatment followed by interval surgery cannot reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis. Early laparoscopic or traditional cholecystectomy within 72 hours may be safer and has definite socioeconomic benefits.