Hot Gallbladders, Cool Outcomes: Bailout Outcomes of Early Laparoscopic Cholecystectomy for Acute Cholecystitis

Introduction Laparoscopic cholecystectomy for acute cholecystitis (hot cholecystectomy) is known to be associated with increased operative difficulty and a higher risk of intraoperative biliovascular complications. Certain bailout strategies have been formulated to mitigate these risks. Most guidelines recommend surgery within seven days of onset of inflammation. The objective of this study is to assess the bailout rate of early cholecystectomy for acute cholecystitis, performed irrespective of the time of presentation but with a target of six weeks from the time of diagnosis. Methods This retrospective cohort study evaluated the outcomes of laparoscopic cholecystectomy over a three-year span (February 2022 to January 2025), comparing patients who underwent early laparoscopic cholecystectomy within six weeks of an acute cholecystitis diagnosis with those who underwent the procedure for a non-inflamed gallbladder. Data analysis was conducted using SPSS Statistics Version 29.0.1.0. Results A total of 355 patients (190 patients in the cholecystitis group and 165 patients in the non-cholecystitis group) underwent cholecystectomy during the period of review. The median duration of surgery was significantly longer in the treatment group than in the control group (80 vs 70 minutes; p = 0.007). There was no statistically significant difference in the rate of subtotal cholecystectomy (3.2% vs 0.6%; p = 0.605) or abandonment of surgery (2.6% vs 0.6%; p = 0.653) between the treatment and control groups. There were no conversions to open cholecystectomy, need for intraoperative percutaneous cholecystostomy or surgery-related mortality in either group. The overall bailout rate, however, was higher in the cholecystitis group (5.8% vs 1.2%, p = 0.039). Conclusion This study indicates that laparoscopic cholecystectomy is safe for acutely inflamed gallbladder even after the first week of onset of inflammation. While the overall surgical bailout rate was significantly higher in patients with acute cholecystitis, individual bailout outcomes were not significantly different from those in the non-cholecystitis group.