# Early laparoscopic cholecystectomy in severely comorbid patients with acute cholecystitis: results of a monocentric study

## TL;DR

The study shows that laparoscopic cholecystectomy is safe and effective for high-risk patients with acute cholecystitis.

## Contribution

It confirms that patients with higher ASA scores can undergo laparoscopic cholecystectomy without increased complications or mortality.

## Key findings

- Laparoscopic cholecystectomy was safe and effective for patients with ASA scores 3-4.
- No significant differences in complications or mortality were observed between ASA groups.
- High-risk patients had longer surgeries and more gangrenous cases but similar outcomes.

## Abstract

Aim: The aim is to evaluate laparoscopic cholecystectomy safety based on American Society of Anesthesiologists score for acute cholecystitis in patients with comorbidities. Patients & methods: This is retrospective study of patients who underwent laparoscopic cholecystectomy for acute cholecystitis between 2003 and 2021. According to their respective ASA-score, patients were divided into group 1: ASA1-2 and group 2: ASA3-4. Results: We collected 578 patients. Even though the gangrenous forms were more frequent and the operative time was longer in group 2, laparoscopic cholecystectomy seems safe and effective. We didn't observe any differences in terms of intraoperative incidents, open conversion rate, or postoperative complications compared with other patients. Conclusion: ASA3-4 patients with acute cholecystitis don't face elevated risks of complications or mortality during laparoscopic cholecystectomy.

This study, involving 578 patients with acute cholecystitis, assessed the safety of early laparoscopic cholecystectomy based on their health scores. Despite longer operative times and more gangrenous forms in higher-scored patients, laparoscopic cholecystectomy was found to be safe and effective. No significant differences in complications or mortality were observed compared with lower-scored patients. In conclusion, early laparoscopic cholecystectomy is considered a safe option for patients with higher health scores facing acute cholecystitis.

Study assessed laparoscopic cholecystectomy safety in high-risk patients with acute cholecystitis based on ASA scores. Despite longer operative times, it's a safe and effective option. #CholecystectomySafety

Laparoscopic cholecystectomy is established as the gold standard for treating acute lithiasic cholecystitis (ALC), as endorsed by guidelines recommending its immediate use to mitigate potential complications.

The investigation revealed that, notwithstanding extended surgical durations and a heightened occurrence of gangrenous ALC among high-risk patients, early laparoscopic cholecystectomy remained a secure and efficacious intervention.

Significant disparities in intraoperative occurrences, conversions to open surgery, or postoperative complications were not observed between the two patient groups.

Nonetheless, patients at elevated risk encountered prolonged postoperative hospitalizations. High-risk individuals exhibited a higher prevalence of comorbidities like diabetes and cardiovascular ailments; however, these factors did not substantially affect surgical outcomes.

While systemic inflammation and specific comorbidities did influence outcomes in the high-risk cohort, laparoscopic cholecystectomy continued to deliver benefits in the form of reduced postoperative complications and abbreviated hospital stays.