COMPARATIVE STUDY BETWEEN EARLY VERSUS DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN CASES OF DELAYED PRESENTATION OF ACUTE CHOLECYSTITIS

Abstract

Background: Gall stones are common and present as acute calculus cholecystitis in 20% of patients with symptomatic disease, with wide variation in severity. The management of patients with gall stone diseases has been revolutionized during the last decade with the introduction and evolution of laparoscopic cholecystectomy. Many studies revealed early laparoscopic cholecystectomy for acute cholecystitis, even beyond 72 hours, which is suggested to be safe and associated with less overall morbidity. Objective: To evaluate and compare early versus delayed laparoscopic cholecystectomy as a management of  patients presented by delayed acute cholecystitis  regarding operative and post-operative outcomes. Patients and Methods: This prospective randomized study was carried out from October 2020 to April 2021 at the Department of General Surgery, Al-Azhar University Hospitals, Cairo, Egypt. It included 40 adult patients with delayed acute calcular cholecystitis. Those patients were classified into two equal groups: Early group in whom laparoscopic cholecystectomy (LC) was done immediately after the first 72 hours till one week, and  Late group in whom LC was done after 6 to 8 weeks of receiving medical treatment. Comparison was applied between the two groups. Results: This study clearly revealed that performing immediate LC within one week for patients presenting with delayed acute cholecystitis in comparison to delayed LC after medical treatment had better outcome. It had the shorter hospital stay, and less postoperative complications. The comparison between two groups revealed that immediate LC in delayed acute cholecystitis had the upper hand of the advantages and the least disadvantages rather than the other group. Conclusion: Early laparoscopic cholecystectomy for patients with delayed acute cholecystitis has both medical and socioeconomic benefits, and it is the preferred approach in comparison to delayed approach.