In patients with acute cholecystitis, performing laparoscopic gallbladder removal within 24 hours of admission, rather than waiting weeks to years after a course of antibiotics has been given, reduces the hospital stay without increasing the risk of complications, new research shows.
The findings, which appear in the Archives of Surgery for June, are based on a review of 173 patients with acute cholecystitis who were admitted to an urban teaching hospital from October 2002 to September 2005.
Seventy-one of the patients (41%) underwent early laparoscopic cholecystectomy, Dr. Robert A. Casillas and colleagues, from Kaiser Permanente Los Angeles Medical Center, report. Of the remaining 102 patients (59%) treated with antibiotics alone, 57 were successfully treated and 45 were not.
Twenty-six of the patients who failed antibiotic therapy underwent late laparoscopic cholecystectomy and 19 were treated with percutaneous cholecystostomy.
Ultimately, 55 patients underwent interval laparoscopic cholecystectomy, defined as removal 2 weeks to 2 years after successful treatment with antibiotics alone or with percutaneous cholecystostomy.
Compared with the interval procedure, early laparoscopic cholecystectomy was associated with a significant reduction in the hospital length of stay. Moreover, the early operation did not increase complications or the rate of conversion to an open procedure.
Despite the advantages seen with early laparoscopic cholecystectomy, it "is not the most common treatment for acute cholecystitis in practice," the authors note.
"For reasons known since the 1960s and now firmly established as valid, efficient, effective, and safe in the laparoscopic era, we renew the plea to our colleagues worldwide to adopt a consistent policy of early laparoscopic cholecystectomy unless specifically contraindicated," the researchers conclude.
Arch Surg 2008;143:533-537.
Reviewed by Ramaz MItaishvili, MD
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