Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Really Safe? Early Cholecystectomy Safely Decreases Hospital Stay in Patients With Mild Gallstone Pancreatitis: A Randomized Prospective Study Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial Acute cholecystitis: delayed surgery or observation. A randomized clinical trial. Long term response to gallstone treatment--problems and surprises. A Randomized Controlled Study of Uncomplicated Gallstone Disease with a 14-Year Follow-Up Showed that Operation Was the Preferred Treatment Symptomatic, non-complicated gallbladder stone disease. Operation or observation? A randomized clinical study. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group. Expectant management of patients with gallbladder stones diagnosed at planned investigation. A prospective 5- to 7-year follow-up study of 153 patients. Relationship between persistence of abdominal symptoms and successful outcome after cholecystectomy. Laparoscopic Cholecystectomy for Acute Cholecystitis: Prospective Trial Needlescopic cholecystectomy: prospective study of 150 patients. Single‐incision versus 3‐port laparoscopic cholecystectomy in symptomatic gallstones: A prospective randomized study
Abstract . The prospect ively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up . The aim of this study was to compare the results of laparoscopic cholecystectomy ( LC ) for acute cholecystitis with that for routine symptomatic gallbladders . The preoperative , intraoperative , and postoperative parameters of 424 routine ( noninflamed ) LCs and 54 LCs for acutely inflamed gallbladders were compared under the “ intention to treat ” principle . Operating time was longer in the inflamed group ( median 97 minutes versus 75 minutes;p < 0.0001 ) . Significantly more adhesions ( 20 % versus 8 % ) , more blood loss ( 48 % versus 19 % ) , a higher incidence of bile spillage ( 28 % versus 12 % ) , and lost stones ( 19 % versus 8 % ) were encountered in patients with acute cholecystitis . Common bile duct ( CBD ) injuries were also more frequent in that group ( 5.5 % versus 0.2%;p = 0.005 ) . The rate of conversion to open surgery was higher than with routine LCs ( 13 % versus 4 % ) . There were two deaths in the routine LC group and none in the acutely inflamed group . There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements . Patients with acute cholecystitis stayed only 1 day longer ( median 4 days versus 3 days ) in hospital . The quality of life scores indicate return to almost normal values by the 14th postoperative day . Long-term follow-up ( 1–3 years ) did not reveal any delayed clinical adverse effects . In summary , LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders . If successfully performed , it has definite benefit for the patient in terms of better postoperative recovery . The trade-off is that the risk of CBD injury is significantly higher Objective : We hypothesized that laparoscopic cholecystectomy performed within 48 hours of admission for mild gallstone pancreatitis , regardless of resolution of abdominal pain or abnormal laboratory values , would result in a shorter hospital stay . Summary of Background Data : Although there is consensus among surgeons that patients with gallstone pancreatitis should undergo cholecystectomy to prevent recurrence , the precise timing of laparoscopic cholecystectomy for mild disease remains controversial . Methods : Consecutive patients with mild pancreatitis ( Ranson score ≤3 ) were prospect ively r and omized to either an  early laparoscopic cholecystectomy group ( within 48 hours of admission ) versus a control laparoscopic cholecystectomy group ( performed after resolution of abdominal pain and normalizing trend of laboratory enzymes ) . The primary end point was hospital length of stay . Secondary end point was a composite of rates of conversion to an open procedure , perioperative complications , and need for endoscopic retro grade cholangiography . The study was design ed to enroll 100 patients with an interim analysis after 50 patients . Results : At interim analysis , 50 patients were enrolled at a single university-affiliated public hospital . Of them , 25 patients were r and omized to the early group and 25 patients to the control group . Patient age ranged from 18 to 74 years with a median duration of symptoms of 2 days upon presentation and a median Ranson score of 1 . There were no baseline differences between the groups with regards to demographics , clinical presentation , or the presence of comorbidities . The hospital length of stay was shorter for the early cholecystectomy group ( mean : 3.5 [ 95 % CI , 2.7–4.3 ] , median : 3 [ IQR , 2–4 ] ) compared with the control group ( mean : 5.8 [ 95 % CI , 3.8–7.9 ] , median : 4 [ IQR , 4–6 ] [ P = 0.0016 ] ) . Six patients from the early group required endoscopic retro grade cholangiography , compared with 4 in the control group ( P = 0.72 ) . There was no statistically significant difference in the need for conversion to an open procedure or in perioperative complication rates between the 2 groups . Conclusion : In mild gallstone pancreatitis , laparoscopic cholecystectomy performed within 48 hours of admission , regardless of the resolution of abdominal pain or laboratory abnormalities , results in a shorter hospital length of stay with no apparent impact on the technical difficulty of the procedure or perioperative complication rate The results of cholecystectomy in terms of symptomatic improvement were prospect ively evaluated in 124 unselected gall stone patients interviewed before and two years after elective surgery . Indications for cholecystectomy were biliary pain ( n = 65 ) , previous complications of gall stone disease ( n = 52 ) , and flatulent dyspepsia ( n = 7 ) . At two years 93 patients could be re-evaluated , of whom only 49 ( 53 % ) were completely symptom free . Postcholecystectomy symptoms occurring in the remaining 44 patients were mainly flatulent dyspepsia ( which had relapsed in 22 of 46 patients who suffered it preoperatively ) , dull abdominal pain or diarrhoea . Incisional hernia was present in five patients and one had recurrence of pain because of retained common bile duct stones . Symptomatic cures after cholecystectomy decreased with the duration of the preoperative history . The results reconfirm that cholecystectomy  eradicates specific symptoms and complications of gall stone disease , but they also show that nearly one half of operated patients are dissatisfied with the procedure because of mild but distressing ' postcholecystectomy ' symptoms . These are probably caused by previously undiagnosed functional gut disease associated with , but unrelated to , gall stones . A systemic approach to multisymptomatic patients with gall stones is recommended BACKGROUND Patients who undergo endoscopic sphincterotomy for common bile-duct stones , who have residual gallbladder stones , are referred for  laparoscopic cholecystectomy .  However , only 10 % of patients who do not have this operation are reported to develop recurrent biliary symptoms . We aim ed to assess whether a wait- and -see policy is justified . METHODS We did a prospect i ve , r and omised , multicentre trial in 120 patients ( age 18 - 80 years ) who underwent endoscopic sphincterotomy and stone extraction , with proven gallbladder stones . Patients were r and omly allocated to wait and see ( n=64 ) or laparoscopic cholecystectomy ( 56 ) . Primary outcome was recurrence of at least one biliary event during 2-year follow-up , and secondary outcomes were complications of cholecystectomy and quality of life . Analysis was by intention to treat . FINDINGS 12 patients were lost to follow-up immediately . Of 59 patients allocated to wait and see , 27 ( 47 % ) had recurrent biliary symptoms compared with one ( 2 % ) of 49 patients after laparoscopic cholecystectomy ( relative risk 22.42 , 95 % CI 3.16 - 159.14 , p<0.0001 ) . 22 ( 81 % ) of 27 patients underwent cholecystectomy , mainly for biliary pain ( n=13 ) or acute cholecystitis ( 7 ) . Conversion rate to open surgery was 55 % in patients allocated to wait and see who underwent cholecystectomy compared with 23 % in those who were allocated laparoscopic cholecystectomy ( p=0.0104 ) . Morbidity was 32 % versus 14 % ( p=0.1048 ) , and median hospital stay was 9 versus 7 days . Quality of life returned to normal within 3 months after either treatment policy . INTERPRETATION A wait- and -see policy after endoscopic sphincterotomy in combined cholecystodocholithiasis can not be recommended as st and ard treatment , since 47 % of expectantly managed patients developed at least one recurrent biliary event and 37 % needed cholecystectomy . No major biliary complications arose , but conversion rate was high BACKGROUND The aim of the present study was to compare the risk of observation versus that of cholecystectomy in acute cholecystitis in patients r and omly allocated to delayed operation or conservative treatment . METHODS One-hundred- and -eighty patients were considered for participation in the study ; 71 were excluded according to predefined criteria and 45 did not join for other reasons . The remaining 64 patients were r and omized to cholecystectomy ( n = 31 ) or observation ( n = 33 ) . R and omized patients were contacted regularly and followed up for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Gallstone-related complications or emergency admissions for pain occurred in six patients in the operation group ( 19 % ; 95 % CI 5%-33 % ) and in 12 patients ( 36 % ; 9 % CI 20%-53 % ) in the observation group . Twenty-seven of 31 patients r and omized to cholecystectomy had a  cholecystectomy  at a median of 3.6 months after r and omization , and , of these , 3 ( 11 % ; 95 % CI 0%-23 % ) suffered a major and 7 ( 26 % ; 95 % CI 9%-42 % ) a minor complication . Ten patients r and omized to observation later had their gallbladders removed , 1 ( 10 % ; 95 % CI 0%-29 % ) patient had a major and 1 ( 10 % ; 95 % CI 0%-29 % ) a minor complication . We found no mortality after cholecystectomy . CONCLUSIONS We found a certain risk of subsequent gallstone-related events following conservative treatment of acute cholecystitis , but the data also show that cholecystectomy should not necessarily be compulsory after acute cholecystitis OBJECTIVE To re-evaluate after 5 years the results of a r and omised trial of cholecystectomy and lithotripsy for the treatment of symptomatic gallstones . DESIGN Late follow-up of a r and omised controlled trial . SETTING Teaching hospital , UK . SUBJECTS 144 of the 179 patients originally r and omised . INTERVENTIONS Either elective open cholecystectomy under general anaesthesia or a maximum of 4 sessions of lithotripsy ( up to 3000 shocks/session ) on consecutive days with no anaesthesia or analgesia . RESULTS Of the original 87 patients r and omised to be treated by lithotripsy , 39 ( 45 % ) subsequently underwent cholecystectomy , most of them within 32 months of treatment ( " crossover " group ) . Patients in both main groups had a pronounced reduction in the number of episodes of pain at 5 years and significant reductions in the mean severity scores both on VAS and the McGill rating . Those in the crossover group had the worst scores . Gastrointestinal symptoms improved in the two main groups , but again the crossover group did least well . Quality of life improved significantly over baseline in the two main groups , but was much poorer in the crossover group . CONCLUSIONS Patients who had primary cholecystectomy were more likely to be free of pain than those treated by lithotripsy . Lithotripsy gave good symptomatic results in 55 % of patients , and this was not dependent on clearance of stones . Patients who had a cholecystectomy after lithotripsy had the worst symptomatic results . It is difficult to identify patients who will not benefit from lithotripsy , but the presence of many coexisting symptoms may be an important predictor Background / Aims : Cholecystectomy is considered the treatment of choice for symptomatic gallstone disease . Some patients abstain from surgery and provide the opportunity to study the natural history of cholelithiasis . The aim of the present study was to examine the feasibility and safety of observation after extended long-term follow-up in a r and omized controlled trial . Methods : A total of 137 patients ( 40.5 % of those assessed ) were r and omized to observation or cholecystectomy and followed up for 14 years . The prevalence of symptomatic events or major complications after treatment was the primary end point . A secondary end point was completion of r and omized treatment . Results : There were no differences in outcome between the observation group and the surgical group ( p = 0.298 ) . Virtually no  cholecystectomy  was performed after 5 years of follow-up , and no clear escalation in the severity of the disease was observed . A total of 50.7 % of patients from the observation group and 88.2 % from the surgical group underwent surgery . The group r and omized to surgery completed their design ated treatment significantly more often ( p < 0.001 ) , especially among patients younger than 70 years of age ( p = 0.005 ) . Conclusion : Cholecystectomy was the preferred treatment after extended long-term follow-up , but conservative management for symptomatic gallstone disease is an alternative to surgery in the elderly BACKGROUND Cholecystectomy has been recognized as the treatment of choice for symptomatic gallbladder stone disease . Not all patients are cured by an operation and the reason for having the gallbladder removed may rest on common practice rather than evidence -based medicine . The aim was to compare cholecystectomy with observation ( watchful waiting ) in patients with uncomplicated symptomatic GBS disease . Three-hundred- and -thirty-eight patients were considered for participation in the study ; 45 patients were excluded according to predefined criteria and 156 did not join for other reasons . The remaining 137 were r and omized to cholecystectomy ( n = 68 ) or non-operative , expectant treatment ( n = 69 ) . METHODS R and omized patients were contacted regularly and followed for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Eight of the patients r and omized to cholecystectomy did not undergo operation , while 35 of the patients r and omized to observation later had their gallbladders removed . The cumulative risk of having a cholecystectomy seemed to level off after 4 years . Gallstone-related complications occurred in 3 patients in the observation group , 1 in the operation group and 5 of 201 excluded patients . After cholecystectomy , 16 of 222 patients had a major complication and 10 a minor . CONCLUSIONS We found that non-operative expectant treatment carries a low risk of complications . Patients should be informed that watchful waiting is a safe option BACKGROUND After cholecystectomy for symptomatic gallstone disease 20%-30 % of the patients continue to have abdominal pain . The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy . METHODS One hundred and two patients were referred to elective cholecystectomy  in a prospect i ve study . Median age was 45 years ; range , 20 - 81 years . A preoperative question naire on pain , symptoms , and history was completed , and the questions on pain and symptoms were repeated 1 year postoperatively . Preoperative cholescintigraphy and sonography evaluated gallbladder motility , gallstones , and gallbladder volume . Preoperative variables in patients with or without postcholecystectomy pain were compared statistically , and significant variables were combined in a logistic regression model to predict the postoperative outcome . RESULTS Eighty patients completed all question naires . Twenty-one patients continued to have abdominal pain after the operation . Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score , ' irritating ' abdominal pain , and an introverted personality and by the absence of ' agonizing ' pain and of symptoms coinciding with pain ( P < 0.000001 ) . In a constructed logistic regression model 15 of 18 predicted patients had postoperative pain ( PVpos = 0.83 ) . Of 62 patients predicted as having no pain postoperatively , 56 were pain-free ( PVneg = 0.90 ) . Overall accuracy was 89 % . CONCLUSION From this prospect i ve study a model based on preoperative symptoms was developed to predict postcholecystectomy pain . Since intra study reclassification may give too optimistic results , the model should be vali date d in future studies OBJECTIVE A prospect i ve r and omized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis . SUMMARY BACKGROUND DATA Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates . It is not known whether there is a role for initial conservative treatment followed by interval elective operation . METHOD During a 26-month period , 99 patients with a clinical diagnosis of acute cholecystitis were r and omly assigned to  early laparoscopic cholecystectomy within 72 hours of admission  ( early group , n = 49 ) or delayed interval surgery after initial medical treatment ( delayed group , n = 50 ) . Thirteen patients ( four in the early group and nine in the delayed group ) were excluded because of refusal of operation ( n = 6 ) , misdiagnosis ( n = 5 ) , contraindication for surgery ( n = 1 ) , or loss to follow-up ( n = 1 ) . RESULTS Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours ( range , 32 to 140 hours ) after admission because of spreading peritonitis ( n = 3 ) and persistent fever ( n = 5 ) . Although the delayed group required less frequent modifications in operative technique and a shorter operative time , there was a tendency toward a higher conversion rate ( 23 % vs. 11 % ; p = 0.174 ) and complication rate ( 29 % vs. 13 % ; p = 0.07 ) . For 38 patients with symptoms exceeding 72 hours before admission , the conversion rate remained high after delayed surgery ( 30 % vs. 17 % ; p = 0.454 ) . In addition , delayed laparoscopic cholecystectomy prolonged the total hospital stay ( 11 days vs. 6 days ; p < 0.001 ) and recuperation period ( 19 days vs. 12 days ; p < 0.001 ) . CONCLUSIONS Initial conservative treatment followed by delayed interval surgery can not reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis . Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy Background : The role of laparoscopic cholecystectomy for acute cholecystitis is not yet clearly established . The aim of this prospect i ve r and omized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy . Methods : Between January 2001 and November 2002 , 40 patients with a diagnosis of acute cholecystitis were assigned r and omly to early laparoscopic cholecystectomy within 24 h of admission ( early group , n = 20 ) or to initial conservative treatment followed by delayed laparoscopic cholecystectomy , 6 to 12 weeks later ( delayed group , n = 20 ) . Results : There was no significant difference in the conversion rates ( early , 25 % vs delayed , 25 % ) , operating times ( early , 104 min vs delayed , 93 min ) , postoperative analgesia requirements ( early , 5.3 days vs delayed , 4.8 days ) , or postoperative complications ( early , 15 % vs delayed , 20 % ) . However , the early group had significantly more blood loss ( 228 vs 114 ml ) and shorter hospital stay ( 4.1 vs 10.1 days ) . Conclusions : Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible , offering the additional benefit of a shorter hospital stay . It should be offered to patients with acute cholecystitis , provided the surgery is performed within 72 to 96 h of the onset of symptoms Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear . A prospect i ve audit of the introduction of laparoscopic cholecystectomy in the west of Scotl and over a two year period was carried out to attempt to assess this new procedure . A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy su bmi tted prospect i ve data from September 1990 - 1992 . A total of 2285 cholecystectomies were audited ( a completed data collection rate of 99 % ) . Laparoscopic cholecystectomy was attempted in 1683 ( 74 % ) patients and completed in 1448 patients ( median conversion rate to the open procedure 17 % ) . The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes ( range 30 - 330 ) and overall hospital stay three days ( 1 - 33 ) . There were nine deaths ( 0.5 % ) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure . In the laparoscopic cholecystectomy group there were 99 complications ( 5.9 % ) , 53 ( 3 % ) of these were major requiring further invasive intervention . Forty patients ( 2.4 % ) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries . There were 11 ( 0.7 % ) bile duct injuries in the laparoscopic cholecystectomy series , five were noted during the initial procedure and six were recognised later result ing from jaundice or bile leaks . Ductal injuries occurred after a median of 20 laparoscopic cholecystectomies . In conclusion laparoscopic cholecystectomy has rapidly replaced open cholecystectomy in the treatment of gall bladder disease . Although the overall death and complication rate associated with laparoscopic cholecystectomy is similar to open cholecystectomy , the bile duct injury rate is higher BACKGROUND Few studies have been done on the expectant management of patients with cholelithiasis diagnosed by planned investigation , and results are conflicting . METHODS A prospect i ve 6-year follow-up study of 153 patients with cholelithiasis diagnosed by oral cholecystography  was carried out . RESULTS An acute gallstone complication occurred during the follow-up period in 23 patients (15%)-that is , acute cholecystitis ( n = 18 ) , acute pancreatitis ( n = 2 ) , and jaundice ( n = 3 ) . The annual risk of developing an acute biliary complication was 3.1 % . A history of a gallstone complication predicted further gallstone complications during follow-up . The overall cholecystectomy rate was 20 % during the 1st year but fell to about 3 % during the 5th year of follow-up . Young age and frequent attacks of biliary pain episodes predicted the need for gallstone surgery . CONCLUSIONS Expectant management of patients with electively diagnosed cholelithiasis may be justified , especially in those with only occasional biliary symptoms and no history of gallstone complications BACKGROUND Patients frequently have persistent abdominal symptoms after undergoing cholecystectomy .  The relationship between abdominal symptoms and biliary dysfunction is often unclear . OBJECTIVES To describe the persistence rate of abdominal symptoms in a large cohort of patients after elective cholecystectomy  , to identify predictors of symptom persistence and operative success , to underst and which symptoms improve after cholecystectomy , and to describe the important determinants of an unsuccessful operation . METHODS Secondary analysis of a prospect i ve , multisite cohort study of 2481 patients undergoing elective cholecystectomy .  RESULTS The mean + /- SD number of abdominal symptoms per patient decreased from 3.1 + /- 2.0 to 1.1 + /- 1.3 ; 27 % of patients who identified a symptom as most bothersome before surgery still had the symptom 6 months after surgery . Symptom persistence rates ranged from 5.6 % ( vomiting ) to 40.2 % ( gas/flatulence ) . A balance score that quantified the abdominal symptom mix between dyspeptic and biliary symptoms shifted after surgery to the dyspeptic category . Predictors of persistence of a most bothersome symptom were dyspeptic symptom category , worse operative risk and self-rated health status , symptom duration longer than 6 months , and no previous episodes of acute cholecystitis . The major correlate of not achieving a very successful outcome ( 15.2 % of patients ) was the presence of postoperative abdominal pain . Other predictors included worse self-rated health status and physical functioning , symptom duration longer than 6 months before surgery , and no previous episodes of acute cholecystitis . CONCLUSIONS Symptoms categorized as dyspeptic were more likely to persist than were biliary symptoms , although all symptoms showed a decrease in prevalence after cholecystectomy . More attention to the rationale for gallbladder removal and clarification of patient expectations for symptom relief might be necessary to improve outcomes after elective cholecystectomy Abstract . This prospect i ve study determines the indications for and the optimal timing of laparoscopic cholecystectomy ( LC ) following the onset of acute cholecystitis . It also evaluates preoperative and operative factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy in the presence of acute cholecystitis . Having been established as the procedure of choice for elective cholelithiasis , LC is now also used for management of acute cholecystitis . Under these circumstances the procedure may be difficult and challenging . Certain favorable and unfavorable conditions may be present that influence the conversion and complication rates . Information about these conditions may be helpful for elucidating the optimal circumstances for LC or when the procedure is best avoided . We performed LC on an emergency basis as soon as the diagnosis was made on all patients presenting with acute cholecystitis from January 1994 to December 1995 . All preoperative , operative , and postoperative data were collected on st and ardized forms . Of the 137 patients registered , 130 were eligible for the audit . Seven patients found by laparoscopic intraoperative cholangiography to have choledocholithiasis were converted for common bile duct exploration and were excluded from the study . Altogether 93 patients ( 72 % ) underwent successful LC and 37 ( 28 % ) needed conversion to open cholecystectomy . The conversion rate of acute gangrenous cholecystitis ( 49 % ) was significantly higher than that for uncomplicated acute cholecystitis ( 4.5 % ) ( p < 0.00001 ) and for hydrops ( 28.5 % ) and empyema of the gallbladder ( 28.5 % ) ( p= 0.004 ) . The difference in conversion between the group with acute necrotizing ( gangrenous ) cholecystitis and the two groups with hydrops and empyema of the gallbladder was not statistically significant ( p= 0.07 ) . The complication rates of acute cholecystitis , hydrops , empyema of the gallbladder , and gangrenous cholecystitis were 9.0 % , 9.5 % , 14.0 % , and 20.0 % , respectively ( p= NS ) . Patients with an operative delay of 96 hours or less from the onset of acute cholecystitis had a conversion rate of 23 % , whereas a delay of more than 96 hours was associated with a conversion rate of 47 % ( p= 0.022 ) . The complication rate was 8.5 % in the laparoscopic group and 27 % in the converted group ( p= 0.013 ) . Patients over 65 years of age , with a history of biliary disease , a nonpalpable gallbladder , WBC count over 13,000/cc , and acute gangrenous cholecystitis were independently associated with a high LC conversion rate ; male patients , finding large bile stones , serum bilirubin over 0.8 mg/dl , and WBC count over 13,000/cc were independently associated with a high complication rate following laparoscopic surgery with or without conversion . Generally , LC can be performed safely for acute cholecystitis , with acceptably low conversion and complication rates . Different forms of cholecystitis carry various conversion and complication rates in selected cases . LC for acute cholecystitis should be performed within 96 hours of the onset of disease . Predictors of conversion and complications may be helpful when planning the laparoscopic approach to acute cholecystitis OBJECTIVE To evaluate the feasibility and safety of cholecystectomy using miniaturised instruments of 3 mm or less in diameter . DESIGN Prospect i ve study on patients with gallstones , with or without related complications . SETTING Private hospital , Hong Kong . PATIENTS From September 1997 to September 2002 , 150 of the 180 consecutive patients managed were included in the present study . MAIN OUTCOME MEASURES All patients were operated on with a st and ard four-port technique . Mini-laparoscopes of different sizes were used throughout the study period , which included 2-mm ( n=33 ) fibre-optic laparoscope , and 2.5-mm ( n=61 ) and 3-mm ( n=56 ) laparoscopes of Hopkins rod lens system . The cystic duct and artery were secured either by extracorporeal ties or 10-mm clips passed through the umbilicus . The time taken from dissection to division of the cystic duct and artery , and to complete the operation were documented . RESULTS The operation was successfully completed with needlescopic instruments in 127 ( 85 % ) patients , even though patients with acute cholecystitis and history of common bile duct stones were included . Use of larger-diameter mini-laparoscopes decreased the time needed to divide the cystic duct and artery , to detach the gall bladder from the liver , and to complete the operation . There were no deaths . One minor bile duct injury developed secondary to extensive cauterisation of the gall bladder fossa . CONCLUSION Needlescopic cholecystectomy with minor technical modification can be completed within a duration comparable to st and ard laparoscopy at no increased risk for the great majority of patients with gallstones Background . Laparoscopic cholecystectomy is the st and ard treatment for symptomatic gallbladder disease .  Single‐incision laparoscopic surgery was developed with the aim of decreasing the invasiveness of conventional laparoscopy . The aim of this study was to compare the clinical outcome of single‐incision laparoscopic cholecystectomy with 3‐port laparoscopic cholecystectomy . Methods . From February 2014 to September 2016 , 187 patients with symptomatic cholecystolithiasis were r and omized to a single‐incision laparoscopic cholecystectomy group ( 89 patients ) or a 3‐port laparoscopic cholecystectomy group ( 98 patients ) . The primary outcomes were a postoperative pain score ( at 6 hours and 1 day ) and patients of complications , while the secondary outcomes were operative time , estimated blood loss , opioid requirements , duration of hospital stay , and patient satisfaction with aesthetic effects . Results . When comparing 3‐port laparoscopic cholecystectomy and single‐incision laparoscopic cholecystectomy , there were differences in the ( mean ± st and ard deviation ) operative time ( 58.9 ± 18.6 minutes vs 45.2 ± 11.8 minutes ; P < .001 ) , success rate ( 93 % vs 99 % ; P < .01 ) , conversion rate ( 7 % vs 1 % ; P < .001 ) , and aesthetic score ( 7.9 ± 1.6 vs 6.7 ± 1.4 ; P = .008 ) . There were no statistically significant differences in estimated blood loss , postoperative pain , opioid requirement , complications , and hospital stay between both groups . Conclusion . Single‐incision laparoscopic cholecystectomy is a safe and feasible procedure in selected patients . The main advantage is the superior aesthetic results , while the main disadvantage is a greater operative time with some technical difficulties
Early laparoscopic cholecystectomy during acute cholecystitis seems safe and shortens the total hospital stay .
BACKGROUND Gallstones are present in about 10 % to 15 % of the adult western population .
Between 1 % and 4 % become symptomatic in a year .
Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis .
OBJECTIVES The aim was to compare the early laparoscopic cholecystectomy ( less than seven days of onset of symptoms ) versus delayed laparoscopic cholecystectomy ( more than six weeks after index admission ) with regards to benefits and harms .