Optimal timing of laparoscopic cholecystectomy in acute calculus cholecystitis

Background: Gallstones affect 5-25% of adults, with 10-15% developing acute calculous cholecystitis (ACC), for which laparoscopic cholecystectomy (LC) is the recommended treatment. Although LC is established as the definitive management for ACC, the optimal timing of surgery remains controversial. Objectives: This study aimed to compare operative time, blood loss, conversion to open surgery, intra- and postoperative complications, hospital stay duration, and the need for drain placement (content and duration) based on surgical timing. Patients and Methods: A comparative cohort study was conducted on patients with calculus cholecystitis at Al Imamain Al-Kadhimain Medical City from July 2023 to February 2025. Patients were divided into three groups according to the timing of surgery from the onset of symptoms. Data collected included sociodemographic details, operative time, conversion to open surgery, complications, and hospital stay. Statistical analysis used the Chi-square test with a significance level set at P< 0.05. Results: The mean patient age was 40.62 ± 11.18 years with a male-to-female ratio of 1:2.3. Group 1 (within 72 hours), Group 2 (between 72 hours and 6 weeks), and Group 3 (after 6 weeks) were compared. Conversion to open surgery was observed in 7 patients in Group 2 (P=0.51). Bleeding was more frequent in Group 2 (16%) compared to Group 3 (8%) with a significant difference (P=0.048). Bile leak was significantly higher in Group 2 (10%) compared to Groups 1 and 3 (P=0.001). Conclusions: Cholecystectomy performed between 72 hours and 6 weeks post-episode was associated with higher complication rates, longer operative times, and prolonged hospital stays.