Early Laparoscopic Cholecystectomy in High-Risk Patients with Acute Cholecystitis

Abstract

Acute cholecystitis is a frequent surgical emergency, especially in elderly patients with several comorbidities. The study was a prospective cohort study carried out at Al-Karama Teaching hospital, Wasit, Iraq, during a period of 36 months (January 2023-January 2026) and involved 58 high-risk patients to determine the safety of early laparoscopic cholecystectomy (ELC) and the short-term outcomes, as well as whether disease sever. The term high-risk was considered as having at least one of the following systemic comorbidities (hypertension, type 2 diabetes mellitus, obesity, ischaemic heart disease, chronic kidney disease, or COPD). The severity of the disease was stratified in terms of the Tokyo Guidelines 2018 (TG18), and the burden of comorbidity was measured through ASA classification and cumulative comorbidity count. Results demonstrated that higher TG18 severity grades were significantly associated with longer operative time, increased complications, a conversion rate of 20.7% (n=12), and prolonged hospital stay (p < 0.05). In contrast, cumulative comorbidity burden had limited impact on most primary outcomes. ELC was successfully completed laparoscopically in 79.3% of cases, with acceptable morbidity and low 30-day mortality (1.7%). In conclusion, ELC is safe in comorbid patients, and TG18 disease severity is the primary determinant of surgical outcomes, outperforming comorbidity burden in predicting operative difficulty and recovery trajectory.