Hepatologie und Pankreaswissenschaft

Is it Justified to use the Lapse Day as a Decision Maker of Laparoscopic Cholecystectomy for Symptomatic Gall Bladder Stone Disease

Abstract

Yu-Chung Chang

Aim: Lapse from symptom onset to surgery has been traditionally used for the operation timing of cholecystectomy. However, intraoperative gallbladder (GB) inflammation status has never been studied to verify its justification.
Methods: Meticulous intraoperative inflammation status of 260 consecutive laparoscopic cholecystectomy (LC) patients with symptomatic GB stone disease was prospectively graded (I-VI). Inflammation status in terms of lapse, incidence of difficult GB, complication and conversion rate from LC to open cholecystectomy was retrospectively analysed.
Results: Various inflammation grades were non-significantly different in each lapse group irrespective of the lapse time. Severity is not always proportionally increased to the lapse time in every patient. One hundred seventeen patients (45%) had inflammations beyond the GB that reached Calot’s triangle or the hepatoduodenal ligament (Grade IV~VI): 64 (54.7%) were Grade V or VI and were defined as difficult GB. There were no statistically significant differences in terms of incidence of difficult GB, or conversion rate between the lapse groups. When divided into any two lapse groups, only the ≤ 3 and >3 days groups showed a significant difference (P=0.039) in the incidence of difficult GB. But the conversion rate was not significantly different (P=0.388).
Conclusion: A majority of the patients were easily manageable despite the different lapse times. Less than onethird of the patients with difficult GB needed earlier LC to avert subsequent progression of dense fibrosis if delayed. Dichotomized lapse determination for LC without considering intraoperative inflammation status is not justified.