The benefit and feasibility of early laparoscopic cholecystectomy in the management of acute cholecystitis
Background: Acute cholecystitis is a common disease. The best management in early cases is surgical, but the optimal timing for surgery remains controversial. With advances and increased experience in laparoscopic surgery, laparoscopic cholecystectomy is increasingly being used in the management of acute cholecystitis. Aims: To determine the best time to operate in acute cholecytitis (early vs. delayed) and to compare the results of laparoscopic approach with those of open surgery in the treatment of acute cholecystitis . Patients and Methods: This was a prospective study done at al‐Yarmouk teaching hospital, Baghdad from Sep. 1st 2012 to Sep. 2nd 2013. All patients admitted with a proved diagnosis of acute cholecystitis were included. The patients were divided into two groups, the first group had early cholecystectomy, laparoscopic (LC) or open (OC). The second group was treated conservatively and delayed cholecystectomy was done. Detailed clinical, investigative and imaging data were recorded. The details of the operative findings, procedures and early post‐operative complications, were documented. Results: There were 146 patients, 82.2% female and 17.8% male. The mean age was 40±2 years. Early surgery was done for 32.8% of patients, 58.4% as a laparoscopic procedure, and 41.6% as an open procedure. Delayed cholecystectomy was done in 67.2% of cases. In the early group,the diﬃculty was minimal in 27.2%, moderate in 39.5%, marked in 25 % and very diﬃcult with conversion done in 8.3%. Early complications were noticed in 4.2% in the early LC group, and 8.3% in the early OC. For delayed LC, 8.1% had early complications vs. 6.1% for delayed OC. Conclusions: Early laparoscopic cholecystectomy is a safe and feasible approach to the management of acute cholecystitis.