OBJECTIVE

To study the clinical and economic features of laparoscopic surgery for acute cholecystitis in delayed presentation.

MATERIAL AND METHODS

A prospective non-randomized study (2020—2021) included 101 patients (73.2% (n=74) men and 26.8% (n=27) women, mean age 58±14.9 years) with acute cholecystitis who underwent laparoscopic cholecystectomy. Cost-effectiveness analysis of laparoscopic cholecystectomy at various periods after clinical manifestation was performed.

RESULTS

Surgical treatment within 72 hours was performed in 15% (n=16) of cases (group 1), within 4—10 days — in 57.5% (n=58) (group 2), after 10 days — in 26.7% (n=27) of patients (group 3). Overall incidence of postoperative complications was 2.9%, postoperative mortality — 1.9% (two patients died from widespread peritonitis). Surgery time was 70 [65—83], 85 [69—110] and 115 [80—125] min (H=15.55, p<0.001), hospital-stay — 6 [5—7], 9 [7—10] and 11 [7—14] days, respectively (H=21.86, p<0.001). Cost of direct (medical and non-medical) treatment amounted to 29484 [27 509—33 885], 41265 [34 306—48 301] and 50591 [37 069—62 483] rubles, respectively (H=29.71, p<0.001)).

CONCLUSION

Delayed hospitalization and surgical treatment of acute cholecystitis after 72 hours are accompanied by higher treatment costs by 29% in the period up to 10 days and by 58% after 10 days. These results require further validation and adjustment in large samples.