T. Kohmura1, J. Yasutomi1, K. Kusashio1, M. Matsumoto1, T. Suzuki1, A. Iida1, K. Fushimi1, S. Irabu1, N. Yamamoto1, N. Imamura1, R. Harano1, A. Yoshizumi1, R. Takayanagi1, I. Udagawa1 1Chiba Rosai Hospital,Surgery,Ichihara, CHIBA, Japan
Introduction:
Tokyo Guidelines 2013 (TG 13) recommend an early operation within 72 hours of the onset of mild or moderate cholecystitis.
Recent?randomized clinical trials have shown that early laparoscopic cholecystectomy shortened hospital stay and the mortality rate and indicated that the complication rate did not increase if laparoscopic cholecystectomy was performed within 7 days of the onset (Br J Surg. 2015 Oct; 102 (11): 1302 -13.).
There has been a controversy regarding early laparoscopic cholecystectomy performed within 7 days of the onset.?In cases of acute cholecystitis, at our hospital, we employ a strategy to perform laparoscopic cholecystectomy under emergency or semi-emergency conditions as long as it is within 7 days of the onset without patients being held without operations for 72 hours. In this study, we investigated if outcomes of our strategy are acceptable.?
Methods:
A retrospective study was conducted on a primary cohort of 168 patients with acute cholecystitis who underwent early laparoscopic cholecystectomy in our institute between 2012 April and 2016 March.
We analyzed the operation time, the amount of bleeding, the conversion to laparotomy, postoperative complications, and postoperative hospital stay. The characteristics were compared and examined in each group based on severity classification by TG 13 and time from onset to surgery.?
Results:
Continuous variables were expressed as median (range). One-hundred and sixty-eight patients underwent laparoscopic surgery (1 case of laparotomy transition). Operation time was 104.5 minutes (33 to 196),amount of bleeding was 10 ml (0 to 1550),postoperative complications occurred in 9 cases, postoperative hospital stay was 5 days (2 to 15).?
In the comparison among the 3 groups according to severity in TG 13, there were no significant differences in the operation time, the rate of transference of the laparotomy, and postoperative complications. A significant difference between the amount of bleeding and the postoperative hospital stay was observed between both severity groups (p <0.01). There was no significant association between the time from the onset to surgery, the bleeding amount, the rate of laparotomy transition, postoperative complications, and postoperative hospital stay.?
Conclusion:In accordance with previous studies, we found that our strategy for early laparoscopic cholecystectomy yields relatively good and acceptable outcomes.