Vargheese Saji, Nelson Thirugnanam, Akhtarkhavari Anis, Patra Satya R, Algud Shivakumar M
General Surgery, Andaman & Nicobar Islands Institute of Medical Sciences, Govind Ballabh Pant Hospital, Port Blair, IND.
Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, IND.
Cureus. 2023 Jun 28;15(6):e41114. doi: 10.7759/cureus.41114. eCollection 2023 Jun.
Background Laparoscopic cholecystectomy (LC) has increasingly been accepted as the procedure of choice for the treatment of acute cholecystitis (AC). However, the timing of this procedure in the management of AC remains controversial. Hence this study was conducted to assess the feasibility of early laparoscopic cholecystectomy in acute cholecystitis. Materials and methods Patients who presented with symptoms of acute cholecystitis such as pain and tenderness in the right upper quadrant, systemic signs of inflammation, and positive ultrasound findings according to Tokyo guidelines were included for evaluation. Group 1 includes patients presented within 24 hours of the onset of symptoms whereas those presented between 25 and 72 hours of the onset of symptoms belonged to Group 2. All patients were taken up for early LC after assessment. Intraoperative and postoperative complications were analysed. Results Out of 120 patients, 37 belonged to Group 1 (30.83%) and 83 belonged to Group 2 (69.17%). There was a significant difference between the study groups in terms of certain demographic, laboratory findings and duration of surgery. None of the patients in Group 1 developed postoperative complications, whereas one patient in Group 2 had a bile leak on postoperative Day 2. Group 2 had a higher conversion rate to open procedure (p = 0.059). The mean duration of hospital stay for patients in Groups 1 and 2 were 3 and 3.3 days, respectively. Conclusion Laparoscopic cholecystectomy is safe and feasible with minimal conversion rates in patients presenting with early symptoms of AC. With the availability of good visualisation, optics, instruments and energy sources, good outcomes can be achieved.
背景 腹腔镜胆囊切除术（LC）已越来越多地被视为治疗急性胆囊炎（AC）的首选术式。然而，该手术在AC治疗中的时机仍存在争议。因此，本研究旨在评估早期腹腔镜胆囊切除术治疗急性胆囊炎的可行性。
材料与方法 纳入根据东京指南出现急性胆囊炎症状（如右上腹疼痛和压痛、全身炎症体征及超声检查阳性结果）的患者进行评估。第1组包括症状发作24小时内就诊的患者，而症状发作25至72小时内就诊的患者属于第2组。所有患者评估后均接受早期LC。分析术中及术后并发症。
结果 120例患者中，37例属于第1组（30.83%），83例属于第2组（69.17%）。两组在某些人口统计学、实验室检查结果及手术时长方面存在显著差异。第1组患者均未发生术后并发症，而第2组有1例患者在术后第2天出现胆漏。第2组转为开放手术的比例更高（p = 0.059）。第1组和第2组患者的平均住院天数分别为3天和3.3天。
结论 对于出现AC早期症状的患者，腹腔镜胆囊切除术安全可行，中转率极低。借助良好的可视化、光学设备、器械及能源，可取得良好疗效。
