Outcomes Best with Prompt Laparoscopic Gallbladder Removal

A recent study concluded that, for best results, laparoscopic surgery to remove an inflamed gallbladder should be done within 48 hours of hospital admission. I’ve been performing surgery since 1997 and perform about 200 gallbladder surgeries each year. Based on my experience, I agree that when possible it’s best to conduct gallbladder surgery sooner rather than later.

Typically, there’s an early window of opportunity in acute cholecystitis where the inflammatory plane makes it relatively easy to separate the gallbladder from surrounding structures. After a few days chronic inflammation and scarring predominate and separating the gallbladder away becomes more difficult and risky. In general surgery, some surgeons have held to the belief that it is best to delay laparoscopic surgery; however, as indicated in the study’s findings, that may not be the best course of action.

The research team studied 4,113 patients who had laparoscopic cholecystectomy for acute cholecystitis at different times; 1,416 on the day of admission (i.e., day 0), 1,542 on day one, 530 on day two, 247 on day three, 218 on days four or five, and 160 on day six or later.

The investigators found that when surgery was delayed for six days or more: rates of conversion to open surgery increased from 11.9 percent on the day of admission to 27.9 percent; post-op complications increased from 5.7 percent to 13 percent; re-operation rates rose from 0.9 percent to 3 percent; and length of hospital stay increased from 6.1 to eight days.

Ideally, the gallbladder should be removed before it reaches the acute stage. Coming in through the emergency room with an inflamed, infected gallbladder increases the risk of problems such as bile leakage, infection and other complications. It also increases the odds of needing open surgery. That’s why I’d like to encourage medical doctors to go ahead and call the surgeon at the first sign of gallbladder problems. When we’re notified right away, we can help prevent problems, get people home sooner, and avoid open surgeries.

I don’t view the 48-hour recommendation as an absolute rule, but it does serve as a good guideline.

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