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

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.