Objective: We are trying to evaluate the competency and safety of surgical management of ACC through LC within and after 72 hours of symptom onset. We are reviewing our experience by comparing the outcomes of both ways to carry out an ideal therapeutic strategy used for ACC.
Background: ACC is a very frequent surgical insult. The timing of surgery in the management of such condition is a subject of controversy among all surgeons. In this study, we tried to share in solving this conflict to implement the optimal timing of LC for ACC.
Patients & Methods: The study includes 100 patients with ACC, divided according to the timing of LC into group E (50 patients), operated within 72 h of symptom onset and group L (50 patients), operated beyond 72 h of symptom onset. Patients in both groups monitored since admission, during operations, and along the PO period. The data collected includes demographic data, clinical data, duration of symptoms before surgery, co-existing disease, laboratory and images results, operative data, PO complications, the length of stay in ICU and the total length of hospitalization.
The results: Fever and Murphy's sign were significantly greater in the early LC group. Initial total bilirubin and BUN are significantly higher (p-value 0.032 and 0.004 respectively) among the late LC group. The operative time and mean total hospital stay are significantly higher (p-value 0.005 and 0.010) in the late LC group compared with the early LC group. The rates of PO bile leakage and port-site infections were higher among patients of late LC group.
Conclusion: Emergent LC is a safe and reliable procedure for ACC within 72 hours of symptom onset. Regarding PO outcomes, financial costs and hospital stay length, it is more helpful than LC beyond 72 hours.
Keywords: Laparoscopic Cholecystectomy, Acute Calculous Cholecystitis, early LC, late LC.
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