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Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis

Hadad, SM; Vaidya, JS; Baker, L; Koh, HC; Heron, TP; Thompson, AM; (2007) Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis. World Journal of Surgery , 31 (6) 1298 - 1301. 10.1007/s00268-007-9050-2. Green open access

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Abstract

Background Randomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate.Methods We performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis.Results Of patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0-2 days, 3-4 days, 5-6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions.Conclusions Early intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.

Type: Article
Title: Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis
Location: Edinburgh, SCOTLAND
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00268-007-9050-2
Publisher version: http://dx.doi.org/10.1007/s00268-007-9050-2
Language: English
Additional information: © Socie´te´ Internationale de Chirurgie 2007
Keywords: RANDOMIZED-TRIAL, GALLBLADDER, METAANALYSIS, MANAGEMENT
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/170926
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