Optimal timing of laparoscopic cholecystectomy after conservative therapy for acute cholecystitis

Abstract Background: Tokyo Guidelines 2018 recommend early surgery for acute cholecystitis. However, some elective surgery cases depend on complications or facility conditions. In this study, we retrospectively analyzed the cases of elective surgery.Methods: This study included 345 patients who underwent laparoscopic cholecystectomy (LC) at our hospital between January 2019 and December 2020. Eighty-three patients underwent LC four days or more after conservative treatment. The elective LC cases were divided into two groups: Early group (4-90 days after onset, n=36) and Delayed group (91+ days after onset, n=31). Percutaneous transhepatic gallbladder drainage cases (n=16) were excluded.Results: The operative times were significantly shorter in the Delayed group (91.2 min, p=0.0108) than the Early group (117 min). However, the amount of blood loss was not significantly different between the two groups. Furthermore, the length of hospital stay was shorter in the Delayed group (3.4 days, p=0.0436) than in the Early group (5.9 days).There were no significant differences in the incidence of complications or the rate of conversion; however, the rates of these two factors were reduced in the Delay group compared to the Early group.Conclusions: If it has become challenging to perform urgent/early LC within three days, due to prior conservative treatment for acute cholecystitis, the operative time and length of hospital stay could be reduced by delaying LC for more than 90 days after the onset. In addition, postoperative complications would not occur, and the conversion rate may be reduced to a low level.