Timing of Early Cholecystectomy: A Multicentric Prospective Observational Study

Fugazzola, P.; Abu-Zidan, F.M.; Cobianchi, L.; Dal Mas, F.; Ceresoli, M.; Coccolini, F.; Frassini, S.; Tomasoni, M.; Catena, F.; Ansaloni, L.; on behalf of the S.P.Ri.M.A.C.C. Collaborative Group. Timing of Early Cholecystectomy for Acute Calculous Cholecystitis: A Multicentric Prospective Observational Study. Healthcare 2023, 11, 2752. Fugazzola, P.; Abu-Zidan, F.M.; Cobianchi, L.; Dal Mas, F.; Ceresoli, M.; Coccolini, F.; Frassini, S.; Tomasoni, M.; Catena, F.; Ansaloni, L.; on behalf of the S.P.Ri.M.A.C.C. Collaborative Group. Timing of Early Cholecystectomy for Acute Calculous Cholecystitis: A Multicentric Prospective Observational Study. Healthcare 2023, 11, 2752.

Abstract

The definition of Early Cholecystectomy (EC) is still debatable. This paper aims to find whether the timing of EC affects outcomes. This is a multicentric prospective observational study including patients with acute calculous cholecystitis (ACC) who had cholecystectomy within ten days from the onset of symptoms. Kruskall-Wallis test, Fisher’s Exact test and Spearman rank correlation were used for statistical analysis. The patients were divided into three groups depending on the timing of the operation: 0-3 days, 4-7 days, or 8-10 days from the onset of symptoms. 1117 patients were studied over a year. The time from the onset of symptoms to EC did not affect the postoperative complications and mortality, the conversion and the reintervention rate. It was a significant risk factor for intraoperative complications (0-3 days, 2.8%; 4-7 days, 5.6%; 8-10 days, 7.9%; p=0.01) and subtotal cholecystectomies (0-3 days, 2.7%; 4-7 days, 5.6%; 8-10 days, 10.9%; p<0.001). ACC is an evolutive inflammatory process and, as the days go by, the local and systemic inflammation increases which makes surgery more complex and difficult with higher risk of intraoperative complications. We recommend performing EC for ACC as soon as possible within the first ten days of the onset of symptoms.

Keywords

acute cholecystitis; cholecystectomy; surgery; timing; complication; mortality

Subject

Biology and Life Sciences, Life Sciences

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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