Outcomes of an Early Laparoscopic Cholecystectomy in Acute Cholecystitis, Grades I and II

Abstract

Objective: According to the accumulated benefits of laparoscopic cholecystectomy (LC) in acute cholecystitis (AC), early LC is becoming a standard management for selected patients. While patients with mild AC usually gain the advantages of this approach, removing a more inflamed gallbladder in patients with moderate AC has various results, depending on the institute where the procedure is performed. The aim of the study was to compare the outcomes between early LC in patients with grade I and II AC. Materials and Methods: From June, 2015 to December, 2019, electronic medical records in the division of Acute Care Surgery at Siriraj Hospital in Bangkok were reviewed retrospectively. An early LC was performed consecutively in 105 cases of AC grades I and II. The overall results and the outcomes comparing grades I and II AC were evaluated. Results: Forty-two patients were grade I (40%). Patients with grade I AC tended to be younger (56 +/- 17 years vs. 63 +/-15 years, p = 0.03). Among grade II patients, the late onset of more than 72 hours was the most common measure (62%). The estimated blood loss was significantly lower in grade I [30 (5-450) ml. vs. 100 (5-3,000) ml., p =0.018]. The overall conversion rate was 21%, which was significantly higher in grade II AC (28.6% vs. 9.5%, p= 0.026). There were no differences in operating time (125 +/- 47 minutes vs. 117 +/- 44 minutes. p = 0.365), total lengths of stay [4 (2-7) days vs. 5 (3-28) days, p = 0.163], and post-operative complications (19% vs 25%, p = 0.448). The minor bile duct injuries occurred in four patients (3.8%), 2 cases in each group. From the multivariate analysis, grade II AC did not statistically impact the conversion (adjusted OR 2.99, 95% CI 0.5-17.6, p = 0.225). Conclusion: Our study shows that the overall and evolving outcomes of early LC for grade I and II AC were safe and feasible. While a higher conversion rate and estimated blood loss attributed to grade II AC, a pre-operative severity grading can guide surgeons to accommodate their ability so as to maximize the benefits of early LC.