Xin Geng1, Cijun Peng1*, Bo Wu1, Weidong Gao1, Yuling Duan1, Guoxin Fan1, Shilong Zhang1, Kangwei Liu1, Kai Li1 and Zanjie Feng2
1Department Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical University, China
2Department of Biochemistry and Molecular Biology, Zunyi Medical University, China
Background: Early Laparoscopic Cholecystectomy (ELC) is superior to Delayed Laparoscopic Cholecystectomy (DLC) for Moderate Acute Cholecystitis (MAC) as defined by Tokyo Guidelines 2018, but the optimal timing of ELC for MAC is still controversial. The purpose of this study was to evaluate the outcomes of ELC in patients with delayed management. Methods: A retrospective analysis was performed of all patients with MAC who underwent LC in Affiliated Hospital of Zunyi Medical University from November 2016 to October 2019. The included patients were classified into three groups according to the time from admission to surgery: Within 7 days (G1), beyond 7 days (G2), at least 6 weeks after antibiotic treatment (G3). Results: A total of 157 patients were included, of which 55 in G1, 43 in G2, and 59 in G3. Conversion rate and perioperative complications were similar in the three groups (G1 3.6% vs. G2 11.6% vs. G3 6.8%, P=0.305) and (G1 5.5% vs. G2 9.3% vs. G3 8.5%, P=0.804), respectively. G1 had a shorter total length of stay (G1 8 vs. G2 14 vs. G3 15 days, P<0.001) and lower costs (14654 vs. 20431 vs. 20801¥, P<0.001). G2 had a longer operative time (G1 92 vs. G2 110 vs. G3 76 min, P<0.001). G3 had a shorter postoperative length of stay (G1 4 vs. G2 4 vs. G3 3 days, P=0.016), drainage tube removal time (2 vs. 2 vs. 2d, P=0.002) and postoperative duration of antibiotic therapy (3 vs. 3 vs. 2d, P<0.001). Postoperative duration of antibiotic therapy (OR=2.953, 95% CI: 1.944 to 4.486, P<0.001) were independent risk factors for postoperative length of stay. Conclusion: ELC is effective and safe in patients with MAC who can tolerate surgery with over 7 days of admission. In addition, rational and appropriate use of antibiotics should be underscored.
Geng X, Peng C, Wu B, Gao W, Duan Y, Fan G, et al. Optimal Timing of Laparoscopic Cholecystectomy for Moderate Acute Cholecystitis: A Cohort Study. Clin Surg. 2021; 6: 3362..