The acute cholecystitis: the operative timing for the laparoscopic approach

The aim of this study is to evaluate the results of early cholecystectomy in patients with acute cholecystitis. In the past, acute cholecystitis was a contraindication to laparoscopic cholecystectomy because of the greater risk of injury to the biliary duct, but acute gallbladder inflammation was a contraindication to open cholecystectomy, too. With greater experience and new technology, laparoscopic cholecystectomy is today the gold standard in the treatment of acute cholecystitis, in empyema and gangrenous cholecystitis. In recent years, attention has turned to surgical timing, rather than surgical management--open versus laparoscopy--because there is no advantage in delaying cholecystectomy for acute cholecystitis. In our experience, we always choose laparoscopic technique in all the patients without general contraindications to mini-invasive surgery and operate as soon as possible in a patient with unfavourable conditions. We believe that the patient must be quickly stabilized with preoperative medical procedures, and surgical treatment must be performed within 72-96 hours after the onset of symptoms. During this period, laparoscopic approach allows a reduction of operative time, operative risk and the conversion rate with medical and economic advantages.