Delayed Laparoscopic Cholecystectomy With Fluorescent Cholangiography for Acute Cholecystitis: Is It Safe?

Background: According to the Tokyo Guidelines 2018 (TG-18), delayed laparoscopic cholecystectomy (DLC) after recovering from acute cholecystitis (AC) is recommended for patients with poor status. Moreover, DLC for patients with good status remains controversial, and TG-18 does not include clinical questions regarding fluorescent cholangiography (FC). In this study, we evaluated the clinical value and safety of FC during DLC.

Methods: We performed DLC in 226 patients after recovering from AC. The electronic medical records of these patients were retrospectively reviewed, focusing on preoperative assessment and intraoperative and postoperative outcomes. Biliary and/or arterial injuries were treated as intraoperative complications.

Results: Of the study patients, 144 underwent DLC with FC. Among the remaining 82 patients who underwent DLC without FC, the rate of intraoperative complications was 7.3% (n = 6), which was significantly higher than in those who underwent DLC with FC (0%) (p = 0.002). The rate of conversion to open cholecystectomy during DLC with FC (1.4%) was significantly lower than that during DLC without FC (15.9%). The mean operative time was not significantly different between the patients who underwent DLC with and without FC (p = 0.503). The mean blood loss and postoperative complications in patients who underwent DLC with FC were significantly lower than those who underwent DLC without FC (p = 0.041 and p = 0.002, respectively).

Conclusions: Utilizing FC can reduce intraoperative and postoperative complications, the conversion rate, and blood loss during DLC; therefore, DLC with FC is recognized as a safe procedure for patients with AC.