J. B. Yuval1, H. Mazeh1, I. Mizrahi1, D. Weiss1, G. Almogy1, M. Bala1, B. Siam1, N. Simanovsky2, E. Kuchuk1, A. Eid1, A. J. Pikarsky1 1Hadassah-Hebrew University Medical Center,General Surgery,Jerusalem, N/A, Israel 2Hadassah-Hebrew University Medical Center,Radiology,Jerusalem, N/A, Israel
Introduction: Acute calculus cholecystitis (ACC) is one of the most common diseases in general surgery and is routinely managed by laparoscopic cholecystectomy (LC). Early and delayed LC are the two practiced approaches while there is inconclusive evidence regarding which is superior. At our medical center delayed cholecystectomy is practiced due to logistical constraints. The aim of this study is to evaluate the advantages and limitations of delayed LC in a large tertiary center.
Methods: A retrospective analysis of all patients admitted to our medical center with ACC between the beginning of 2003 and the end of 2012 was performed. Data collected included patient demographics and comorbidities, presenting symptoms, laboratory findings, blood cultures and imaging results. Data also included length of stay (LOS), time until surgery, and surgical complications.
Results: During the study period 1078 patients were admitted to our institution with the diagnosis of ACC. Of the entire cohort there were 593 females (55%) and the mean age was 57±1.5 years. Mean LOS at initial admission, re-hospitalization until surgery, and following delayed surgery were 7.0±0.7, 1.5±0.4, and 3.4±0.8, days, respectively. During the index admission 24% of patients required insertion of a cholecystostomy tube due to lack of improvement with conservative management. Only 640 (59%) patients eventually underwent delayed LC. Mean time from index admission to surgery was 97±12 days and 15% of patients were re-hospitalized in this time period. Conversion rate to open surgery was 5.8% and common bile duct (CBD) injury occurred in 1.1%. Postoperative complications occurred in 9.8% of the patients and the 30-day mortality was 0.6%.
Conclusion: The delayed LC approach is associated with significant loss of follow-up, long LOS, and robust use of PC. Conversion rates are lower than reported in the literature while the rates of bile duct injury and perioperative mortality are comparable.