Early Laparoscopic Cholecystectomy for Acute Acalculous Cholecystitis

Background Acute acalculous cholecystitis refers to gallbladder dysfunction associated with stasis, inflammation or infection in the absence of sludge or gallstones. Increased pressure within the gallbladder due to stasis, inflammation and infection leads to hypoperfusion of the gallbladder wall ranging from mild oedema and ischemia to gangrene and necrosis. Early laparoscopic cholecystectomy within 7 days after the onset of symptoms is the recommended treatment modality for mild and moderate acute cholecystitis. This study aims to evaluate the safety and efficacy of early laparoscopic cholecystectomy in acute acalculous cholecystitis patients. Methods The study included 276 consecutive acute cholecystitis patients who had laparoscopic or open surgery for acute cholecystitis within the first admission. Of these, 239 had gall stones (group 1) and 37 had no gall stones (group 2). Using the patient records, analyses were made based on gender, age, co-morbidities, laboratory tests, the surgical procedure (open, laparoscopic), length of stay, complications, and mortality rates. Results No statistically significant differences were observed between calculous and acalculous acute cholecystitis patients regarding conversion to open surgery and the incidence of general or surgical complications, including gallbladder perforation, abscess, surgical complications, bleeding, bile leakage, biliary tract injury, and wound infection. This outcome suggests that performing laparoscopic surgery can be a safe approach during the initial admission for both calculous and acalculous acute cholecystitis patients. Conclusion Early laparoscopic cholecystectomy, if clinically feasible, may contribute to reduced morbidity, a shorter hospital stay, and a lower risk of disease progression or the need for more invasive interventions for acute acalculous cholecystitis patients.