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Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 h of symptom onset

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Abstract

Laparoscopic cholecystectomy (LC) performed for acute cholecystitis (AC) is usually advised within 72 h of symptom onset. This study aimed to evaluate the outcomes of LC beyond 72 h after presentation. A total of 94 patients underwent LC for AC between January 2012 and February 2015: 70 underwent early LC (ELC, operation within 72 h of symptom onset) and 24 underwent late LC (LLC, beyond 72 h). The outcomes of the groups were compared. Preoperative C-reactive protein (CRP) levels were significantly higher in the LLC group [9.81 (0.41–38.00) mg/dL] compared to the ELC group [1.05 (0.05–24.20) mg/dL; P = 0.001]. Between-group differences were also observed in operative time, blood loss, and postoperative hospital stay [ELC, 76 (37–141) minutes, 10 (1–650) ml and 4 (3–12) days; LLC, 89 (48–234) minutes, 40 (1–3500) ml, and 6 (4–35) days; P = 0.048, 0.007, and <0.001]. The conversion rate of laparoscopic to open cholecystectomy was significantly higher in the LLC group (17%) than the ELC group (1%; P = 0.014). Univariate analysis identified LLC, CRP ≥10 mg/dL, and failure to create a critical view of safety as risk factors for conversion to open surgery, while operative time ≥90 min and blood loss ≥100 ml were risk factors for complications. LLC is associated with longer operation times, greater blood loss, longer hospital stays and higher conversion rates than ELC. Using a high CRP value as a criterion for selecting a surgical procedure, whether open or laparoscopic, would decrease the conversion rate of LLC, which may reduce operation times and blood loss.

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Authors and Affiliations

  1. Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan

    Shunsuke Onoe, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama & Yasuyuki Fukami

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  1. Shunsuke Onoe
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  2. Yuji Kaneoka
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  3. Atsuyuki Maeda
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  4. Yuichi Takayama
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  5. Yasuyuki Fukami
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Correspondence to Shunsuke Onoe.

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We declare that in the study were respected the ethical standards conformed to the guidelines of the Helsinki Declaration. No study advertising was made and no remuneration was offered.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Onoe, S., Kaneoka, Y., Maeda, A. et al. Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 h of symptom onset. Updates Surg 68, 377–383 (2016). https://doi.org/10.1007/s13304-016-0409-5

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  • DOI: https://doi.org/10.1007/s13304-016-0409-5

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