Comparative Study Between Early and Interval Surgical Laparoscopic Intervention of Acute Cholecystitis

Acute calculous cholecystitis (ACC) is one of the most common emergencies in general surgery. In the past, acute cholecystitis was a contraindication of laparoscopic cholecystectomy, and patients with acute cholecystitis were managed conservatively and readmitted for elective laparoscopic cholecystectomy (LC) after 6-8 weeks. With the increased experience in laparoscopy, surgeons started to attempt early laparoscopic cholecystectomy for acute cholecystitis. This work aims to compare intraoperative and postoperative outcomes of early versus interval cholecystectomy in Acute cholecystitis. Our study was conducted on 100 patients divided into two groups of 50 each to compare the results of early surgery with delayed surgery. The correlation between the two groups showed that there is a statistically significant difference in favour of group (A) denoting that surgery in the early group is more economical because of less hospital stay. Total hospital stays in group (A) ranged from 3.5 to 6 days with a mean of 4.8 ± 0.91 days. While total hospital stays in the group (B) (including the number of days spent till the resolution of the acute attack of cholecystitis along with the number of days spent after readmission for laparoscopic cholecystectomy) ranged from 7 to 12 days with a mean of 9.2 ± 1.61 days. The conversion rate from laparoscopic cholecystectomy to open cholecystectomy between the two groups is not significantly different and the overall post-operative complication rate. However, operative time in group (A) ranged from 55 to 140 minutes, with a mean operative time of 100.3 ± 14.75 minutes. For the cases which were converted to open cholecystectomy the operative time ranged from 112 to 140 minutes with a mean of 125.6 minutes. While operative time in group (B) ranged from 45 to 106 minutes and the mean operative time was 80.3 ± 12.4 minutes. For the cases which were converted to open cholecystectomy the operative time ranged from 95 to 106 minutes with a mean of 101.75 minutes. The correlation between the two groups showed that there is statistically significant difference in favor of group (B) and this is due to difficult dissection at Calot’s triangle in early lap. cholecystectomy. From our study, we can conclude that the laparoscopic cholecystectomy in early cholecystectomy up to 96 hr from the starting of acute symptoms was found to be more economical with less total hospital stay and less total cost of the therapy than interval cholecystectomy in acute cholecystitis.