Surgical Hotspot: Evaluating the Safety of Day-case Early Cholecystectomy for Acute Cholecystitis

BACKGROUND: Laparoscopic cholecystectomy is increasingly being performed as a day-case procedure globally, and the previously held notion of 'interval cholecystectomy' is now being abandoned in favour of early cholecystectomy. Cholecystectomy for acute cholecystitis is associated with an increased risk of operative difficulty and intraoperative complications. AIMS: This study aimed at is to assess the safety of day-case laparoscopic cholecystectomy (DCLC) for acute cholecystitis. METHODS: Author to summarize the data collected over 3 years (February 2022 to January 2025) on patients scheduled for either 'urgent' or 'very urgent' laparoscopic cholecystectomy for acute cholecystitis. Data analysis was done with IBM SPSS Statistics 29.0.1.0. RESULTS: A total of 190 patients (age range 22-96 years, median 54) underwent urgent or very urgent laparoscopic cholecystectomy for 'hot gallbladder'; 145 (76.3%) were discharged on the same day, while 45 (23.7%) required overnight admission due to surgical difficulty or significant co-morbidities requiring monitoring. Out of the 145 day-case patients, the mean intraoperative difficulty score was 2.34 (on a scale of 1-4), with surgery durations ranging from 25 to 205 min (median of 75 min). Only four patients (2.8%) were readmitted within 30 days due to subhepatic abscess, post-operative pain, wound collection and hernia, but none required reoperation, and there was no mortality. CONCLUSION: DCLC for acute cholecystitis is safe and feasible for the majority of patients, even in complex cases. These results support the increasing role of early and day-case surgery in the management of acute cholecystitis. Enhanced pre-operative patient selection and optimisation, judicious use of surgical drains, streamlined theatre logistics and improved perioperative pain management could further improve the success of day case surgeries and enhance patient quality of life after laparoscopic cholecystectomy.