Randomized single centre study, surgical timing and conversion factors in 100 consecutive patients treated for acute cholecystitis

Introduction: The aim of this study is to evaluate which factors might influence the decision and the time of conversion in the laparoscopic treatment of acute cholecystitis. Materials and methods: A monocentric retrospective study was performed on 100 patients affected by acute cholecystitis. The group A, consisting of 15 males (30%) and 35 females (70%) was treated with early laparoscopic cholecystectomy. The group B, consisting of 16 males (32%) and 34 females (68%), was undergoing delayed laparoscopic cholecystectomy approximately after 40 days. Results: The differences between group A and group B were the incidence of laparotomic conversion (22% in the group A vs 10% in the group B) and the operating time (110' group A vs 75' group B). Time of hospitalization was shorter in patients undergone to early surgery (5 days) compared to patients undergone to delayed surgery (8,5 days). Postoperative complications rate was of 10% in group A and 6% in group B. Cases of mortality were not reported. Factors that influenced conversion to laparotomic surgery were: belonging to male sex, leukocytosis (>18000 WBC) and PCR (>20 MG/DL). In acute forms edema and tissues friability were common causes that hindered the dissection of the concerning structures. Instead, the new formed adherences observed in patiens undergone to delayed surgery has not been an obstacle to dissection. Conclusions: Laparoscopic surgery represents gold standard in the acute cholecystitis treatment. In our experience, delayed surgery showed a lower rate of conversion and morbility.