Open AccessDelay from Symptom Onset Increases the Conversion Rate in Laparoscopic Cholecystectomy for Acute Cholecystitis
Author(s) -
Hadad Sirwan M.,
Vaidya Jayant S.,
Baker Lee,
Koh Hoey C.,
Heron Timothy P.,
Hussain Kashif,
Thompson Alastair M.
Publication year - 2008
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-008-9750-2
Subject(s) - abdominal surgery , medicine , cardiothoracic surgery , cardiac surgery , vascular surgery , laparoscopic cholecystectomy , cholecystectomy , acute cholecystitis , cholecystitis , general surgery , surgery , gallbladder
BACKGROUNDRandomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate.METHODSWe performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis.RESULTSOf patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0-2 days, 3-4 days, 5-6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions.CONCLUSIONSEarly intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.