Delayed Laparoscopic Cholecystectomy With Fluorescent Cholangiography for Acute Cholecystitis: Is It Safe?

According to the Tokyo Guidelines 2018 (TG-18), delayed laparoscopic cholecystectomy (DLC) after recovering from acute cholecystitis (AC) is recommended for patients with poor status. Moreover, DLC for patients with good status remains controversial, and TG-18 does not include clinical questions regarding fluorescent cholangiography (FC). In this study, we evaluated the clinical value and safety of FC during DLC.

We performed DLC in 226 patients after recovering from AC. The electronic medical records of these patients were retrospectively reviewed, focusing on preoperative assessment and intraoperative and postoperative outcomes. Biliary and/or arterial injuries were treated as intraoperative complications.

Of the study patients, 144 underwent DLC with FC. Among the remaining 82 patients who underwent DLC without FC, the rate of intraoperative complications was 7.3% (n = 6), which was significantly higher than in those who underwent DLC with FC (0%) (p = 0.002). The rate of conversion to open cholecystectomy during DLC with FC (1.4%) was significantly lower than that during DLC without FC (15.9%). The mean operative time was not significantly different between the patients who underwent DLC with and without FC (p = 0.503). The mean blood loss and postoperative complications in patients who underwent DLC with FC were significantly lower than those who underwent DLC without FC (p = 0.041 and p = 0.002, respectively).

Utilizing FC can reduce intraoperative and postoperative complications, the conversion rate, and blood loss during DLC; therefore, DLC with FC is recognized as a safe procedure for patients with AC.