Timing of laparoscopic cholecystectomy in acute cholecystitis

Background. Laparoscopic cholecystectomy is associated with an increased conversion rate in acute cholecystitis. Aim. To review the operative management of symptomatic cholelithiasis with particular reference to conversion rates and morbidity for laparoscopic cholecystectomy for acute cholecystitis. Methods. Patients undergoing cholecystectomy between January 1994 and December 1998 were recruited. Demographic details, diagnosis, duration of symptoms, treatment, outcome, post-operative stay and complications were recorded. Results. Complete data were available on 482 patients (84%). Laparoscopic cholecystectomy was attempted in 120 of 132 patients (91%) with acute cholecystitis and 329 of 350 patients (94%) with non-acute gallbladder disease. Conversion rates were 27% (33/120) and 6.7% (22/329) for acute and non-acute gallbladder disease, respectively (p<0.001 χ² test). Relating the interval from onset of symptoms to surgery, conversion rates for acute cholecystitis were: <3 days, 5/17 (29%); 4 to 42 days, 14/59 (23%) and >42 days, 14/44 (31%). There were three bile duct injuries, two in the delayed (>45 days) acute group and one in the non-acute group. Conclusion. Early laparoscopic cholecystectomy is the treatment of choice for acute cholecystitis, but is associated with a high conversion rate independent of the timing of surgery.