Timing of cholecystectomy in recurrent attacks of acute cholecystitis

Abstract

BACKGROUND: Although laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis, its optimal timing is still controversial. In this study, our aim is to determine the appropriate cholecystectomy time by comparing the results of emergency and elective cholecystectomy in patients presenting with recurrent acute cholecystitis. METHODS: Between January 2019 and January 2022, the data of 434 patients who were scheduled for late cholecystectomy and were admitted to our hospital with recurrent cholecystitis attacks during the waiting period were retrospectively evaluated. Demographic data of patients, stage according to Tokyo Guidelines 2018, duration of hospital stay before and after surgery, surgery duration, open surgery rate, drain use, hollow organ injury, biliary tract injury, bleeding, wound infection, post-operative collection, and mortality rates were analyzed. RESULTS: Emergency LC (group 1) was performed in 176 (40.5%) of 434 patients presenting with recurrent cholecystitis, and elective LC (group 2) was performed in 258 (59.5%) patients. Pre-operative hospital stay was significantly longer in group 2, and mean surgery duration was significantly longer in group 1 (p=0.001 and p=0.035, respectively). Gastric or intestinal injury, biliary tract injury, wound infection, and mortality were not detected in either group. There was no significant difference between the groups in the rate of open surgery and postoperative collection rates (p>0.05). CONCLUSION: In centers experienced in hepatobiliary surgery, LC can be safely performed in recurrent acute cholecystitis attacks, regardless of symptom duration and the number of attacks.