International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2021, 9(3), 96-98
DOI: 10.12691/ijcd-9-3-1
Open AccessArticle

Any Time Laparoscopic Cholecystectomy in Moderate to Severe Acute Cholecystitis without Septic Shock

Bhavin B Vasavada1, and Hardik Patel1

1Consultant Hepatobiliary and Liver Transplant, Shalby Hospitals, Ahmedbad, Gujarat, India

Pub. Date: November 10, 2021

Cite this paper:
Bhavin B Vasavada and Hardik Patel. Any Time Laparoscopic Cholecystectomy in Moderate to Severe Acute Cholecystitis without Septic Shock. International Journal of Celiac Disease. 2021; 9(3):96-98. doi: 10.12691/ijcd-9-3-1


Introduction: There is an ongoing debate over the timings of laparoscopic cholecystectomy in acute cholecystitis. Most authors recommend surgery within the first 72 hours. We offer laparoscopic cholecystectomies in every patient with acute cholecystitis regardless of the timing of presentation. Material and methods: We prospectively analyzed outcomes of our protocol of any time acute cholecystitis. We perform laparoscopic cholecystectomies within the first 24 hours of presentation to us without considering time since attack if the patient is not in septic shock where we follow survival sepsis guidelines. Results: We performed 110 laparoscopic cholecystectomies between April, 2019-March, 2020. We prefer single-dose preoperative antibiotics (third-generation cephalosporin) in all laparoscopic cholecystectomies. A total of 79 patients were having acute cholecystitis. 67 patients were having grade 2 and 12 patients were having grade 3 cholecystitis according to Tokyo guidelines. 50 patients were presented more than 72 hours after the attack. 21 patients presented more than 48 hours but less than 72 hours. 8 patients presented within 24 hours. The mean duration of the presentation was 120 hours. 5 patients presented after more than 7 days. One patient was having grade 3 cholecystitis and was having septic shock so he was managed with percutaneous cholecystostomy and according to survival sepsis, protocol and lap choly were done after 72 hours. Out of 79 patients included in the study, 2 patients were converted to open; in 3 patients we performed lap subtotal cholecystectomy due to difficult calot triangle. Out of these only 2 patients developed port site infection and 3 patients developed bilioma which was managed by percutaneous drainage. All patients were discharged the same day or the next day. Only two patients with bilioma were readmitted. Rest all of the patients had an uneventful recovery. Conclusion: There is no need to strictly follow the 72-hour time limit for laparoscopic cholecystectomy in acute cholecystitis. Any time laparoscopic cholecystectomy should be the rule inexperienced centre.

laparoscopic cholecystectomy acute cholecystitis gall stone sepsis surgical site infection

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[1]  Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015 Jun; 18: 196-204.
[2]  C M Lo, C L Liu, S T Fan, E C Lai J Wong. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998 Apr; 227(4): 461-467.
[3]  Rutledge D, Jones D, Rege R. Consequences of delay in surgical treatment of biliary disease. Am J Surg. 2000 Dec;180(6):466-9
[4]  Uchiyama K, Onishi H, Tani M, Kinoshita H, Ueno M, Yamaue H. Timing of laparoscopic cholecystectomy for acute cholecystitis with cholecystolithiasis. Hepatogastroenterology. 2004 Mar-Apr; 51(56): 346-8.
[5]  Gurusamy KS1, Samraj K. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev. 2006 Oct 18; (4).
[6]  Hsieh YC, Chen CK, Su CW, Chan CC, Huo TI, Liu CJ, et al. Outcome after percutaneous cholecystostomy for acute cholecystitis: a single-center experience. J Gastrointest Surg. 2012 Oct; 16(10): 1860-8.
[7]  Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R6 Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017 Mar; 43(3): 304-377.
[8]  Morgenstern L, Wong L, Berci G. Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison. Arch Surg. 1992 Apr; 127(4): 400-3.
[9]  Chen AY, Daley J, Pappas TN, Henderson WG, Khuri SF. Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes. Ann Surg. 1998 Jan; 227(1): 12-24.
[10]  Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campbell KA, Talamini MA et al. Postoperative bile duct strictures: management and outcome in the 1990s.Ann Surg. 2000 Sep; 232(3): 430-41.
[11]  Walker AT, Shapiro AW, Brooks DC, Braver JM, Tumeh SS. Bile duct disruption and biloma after laparoscopic cholecystectomy: imaging evaluation. AJR Am J Roentgenol. 1992 Apr; 158(4): 785-9.
[12]  Bogdanic B, Bosnjak Z, Budimir A, Augustin G, Milosevic M, Plecko V, et al. Surveillance of surgical site infection after cholecystectomy using the hospital in Europe link for infection control through surveillance protocol. Surg Infect (Larchmt). 2013 Jun; 14(3): 283-7.
[13]  Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004 Sep; 18(9): 1323-7.
[14]  Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003 Jul-Aug; 7(5): 642-5.
[15]  Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW. Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg. 2000 Sep; 66(9): 896-900.