TPW 4.05 Does Timing of Emergency Laparoscopic Cholecystectomy Impact Surgical Outcomes?

Abstract

To examine outcomes of emergency laparoscopic cholecystectomies performed at days 7-14 of symptoms, a period associated with higher risk (‘danger window’) versus those operated outside this period. All emergency laparoscopic cholecystectomies performed between 28/08/2023 and 27/12/2024 at a tertiary general surgery centre were included. 914 eligible cases were included. Data were extracted from the electronic patient record. 318 of 914 (34.7%) cases were operated within the ‘danger window’. Both groups were demographically similar. There were no inter-group differences in procedure duration, conversion rate, complication incidence, Clavien-Dindo grade distribution, postoperative length of stay, readmission rate or re-intervention rate (p > 0.05). 8 bile leaks were identified and were equally distributed between groups (p >0.05) Excluding cholecystectomy for biliary colic, 256 of 703 (36.4%) cases were operated in the ‘danger window’. Demographics between groups were statistically similar. There were no differences in operating time, conversion rate, complication rate, Clavien-Dindo grade distribution, post operative length of stay, readmission, or reintervention (p > 0.05). However, there was significant difference in rate of bile leak, with all 4 cases occurring in patients operated in the danger window (p < 0.05). No major bile duct injuries occurred in this series. The outcomes of emergency cholecystectomy are similar regardless of timing of intervention. In non-biliary colic cases, operating between 7-14 days confers increased risk of bile leak at 1.5% of cases, which approaches quoted rate for uncomplicated gallstone disease. These data challenge the persistent dogma of an unsafe window for emergency laparoscopic cholecystectomy.