Differences in outcome of acute and elective laparoscopic cholecystectomy

Background/Aims: To assess the differences in outcome of acute and elective laparoscopic cholecystectomy. Methods: Data from 630 consecutive patients who presented for laparoscopic cholecystectomy due to acute cholecystitis (n = 98) or non-acute gallstone disease (n = 532) were studied prospectively. Results: The conversion rate was significantly higher for acute cholecystitis (33%) than for non-acute gallstone disease (4%). For acute cholecystitis the timing of operation was crucial to the execution of a successful laparoscopic procedure. The existence of a learning curve was demonstrated by the fact that the mean operation room time for elective cholecystectomy decreased from 105 to 87 min between the first and the second half of the study time, whereas no significant decrease in operation room time was recorded for acute operations. For both acute and elective patients, complication rates were significantly higher among those over the age of 70 years. General complications, largely cardiopulmonary, were more frequent after acute operations (14%) than after elective operations (0.6%), whereas procedure-related complications were not significantly different between the 2 groups (8 and 6%, respectively). In addition, the overall postoperative morbidity increased significantly for both the acute and elective group if the laparoscopic procedure was converted to an open operation. Conclusion: It is too early to proclaim laparoscopic cholecystectomy as the procedure of choice in acute cholecystitis. However, a policy of reducing the delay of operation after the onset of symptoms may reduce the incidence of complications and conversion rate.