Early vs Delayed Cholecystectomy in Acute Cholangitis/Acute Cholecystitis

No significant differences in intraoperative or postoperative complication risk rates were seen in patients who underwent early or delayed cholecystectomy for acute cholangitis with concomitant acute cholecystitis, according to a study published in the Annals of Medicine and Surgery.

The revised 2013 Tokyo guideline recommends that early cholecystectomy should be performed within 72 hours of symptom onset of acute cholecystitis, however, the appropriate time interval between the treatment of the frequently concomitant comorbidity of acute cholangitis and surgical intervention remains unknown. Recent data have shown that this time limitation may be extended to 7 days without increased risk for perioperative complications. Therefore, this study investigated the optimal timing and usefulness of early cholecystectomy for acute cholecystitis in patients with comorbid acute cholangitis.

Between 2011 and 2016, 252 consecutive patients (163 male, 89 female; age range, 9-99 years) who underwent urgent cholecystectomy and 7 patients who underwent delayed cholecystectomy were included in the study. The patients with comorbid acute cholangitis were further divided into those who underwent urgent cholecystectomy (within 72 hours of symptom onset), semi-urgent cholecystectomy (3-14 days after symptom onset), or delayed cholecystectomy (3 months after symptom onset). Postoperative complications were defined as those that were grade 3a or greater.

Results showed few differences in perioperative outcomes between patients with and those without acute cholangitis. However, the length of postoperative hospital stay was significantly longer in patients with such concomitant biliary infections group (9 days vs 7 days, P =.004). Operative time and postoperative complication rates were similar between the 2 groups (P =.496 and P =.561, respectively). In addition, intraoperative blood loss showed an insignificant difference between the 2 groups (P =.151). All 3 subgroups of patients with concomitant acute cholangitis were comparable for both intraoperative and postoperative outcomes. Neither were there significant differences between these groups in operative procedures (P =.705), operation time (P =.548), intraoperative bleeding (P =.106), postoperative complications (P =.686), or postoperative hospital stay (P =.475).

Overall, the study authors concluded that this first-of-its-kind study “demonstrated the feasibility and safety of cholecystectomy performed within 14 days after symptom onset for patients with comorbid acute cholecystitis and acute cholangitis after successful treatment for acute cholangitis.”

Reference

Abe T, Amano H, Hanada K, et al. Efficacy and safety of early cholecystectomy for comorbid acute cholecystitis and acute cholangitis: retrospective cohort study. Ann Med Surg (Lond). 2019;38:8-12.