An evaluation of early and delayed laparoscopic cholecystectomy for acute cholecystitis

Imbisat, Md Zaid; Rizvi, S. A. A.; Ali, Imad

doi:10.18203/2349-2902.isj20193680

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…Moreover, complications while awaiting cholecystectomy that should also be primarily considered in delayed cholecystectomy are rarely reported. At the contrary, the failure rate of conservative treatments and re-admission for the recurrence of symptoms of acute cholecystitis in the delayed cholecystectomy group while awaiting cholecystectomy was reported in several studies to be up to 33% and 33.3% of cases, respectively 15,27,28,30,31,[33][34][35]37,45,49,50,51 .…”

Section: Discussionmentioning

confidence: 99%

“…The characteristics and the results of the studies reporting data on immediate versus delayed cholecystectomy are summarized in Table 2. In total, 20 studies were excluded for the following reasons: the absence of or uncertainty about randomization [40][41][42][43][44] , lack of reporting or uncertainty about timing 40,[45][46][47][48]52 , lack of reporting or uncertainty about diagnostic criteria for acute cholecystitis 40,44,45,[49][50][51]53 , limitation of the population study to the rst episode and inclusion of biliary colic cases 51 , the inclusion of only patients with symptoms persisting for more than 72 hours 52 , exclusion of elderly patients 53 , lack of reporting postoperative complications or lack of specifying whether the reported complications were primarily postoperative 40,47,48,[53][54][55][56][57] , or the study reported interim results of a randomized study 58 .…”

Section: Study Characteristicsmentioning

confidence: 99%

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Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.

Borzellino

Khuri

Pisano

et al. 2020

Preprint

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Background Early cholecystectomy for acute cholecystitis is reported in the literature to be performed up to 96 hours of admission or up to 1 week of the onset of symptoms. Based on the natural history of acute cholecystitis such timing may have missed some potential benefits that could have been expected by performing cholecystectomy in an earlier phase of the disease. The study aimed to explore the hypothesis that an immediate cholecystectomy performed within 24 hours of admission could reduce post-operative complications when compared with delayed cholecystectomy. Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complications at different timings of cholecystectomy for acute cholecystitis were included. The main outcome was the post-operative complication rate. Studies were grouped based on the timing of cholecystectomy which was defined immediate when performed within 24 hours of admission, early when performed up to 96 hours of admission and delayed when surgery was elective after medical treatment. Pooled data of studies comparing post-operative complications after immediate versus delayed and early versus delayed cholecystectomy were analysed within a sub-group analysis. The literature search finding allowed the performance of a second analysis in which immediate cholecystectomy did not refer to a cholecystectomy performed within 24 hours of admission but within 72 hours of the onset of symptoms. Results Immediate cholecystectomy performed within 24 hours of admission did not prove to reduce post-operative complications with relative risk (RR) 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, immediate cholecystectomy performed within 72 hours of the onset of symptoms was found to reduce post-operative complications compared to delayed cholecystectomy with RR 0.57 [95% CI: 0.37;0.89]. Conclusion The present study did not confirm the hypothesis that immediate cholecystectomy performed within 24 hours of admission may reduce post- operative complications. However, the finding of studies in which timing referred not to admission but to the onset of symptoms, allows to favour immediate cholecystectomy if performed within 72 hours of the onset of symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.

Borzellino

Khuri

Pisano

et al. 2020

Preprint

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Preoperative Evaluation and Management of Acute Cholecystitis: Optimal Timing and Surgical Approach

Cruz

Han

2021

Difficult Acute Cholecystitis

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Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials

et al. 2021

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Background Early cholecystectomy for acute cholecystitis has proved to reduce hospital length of stay but with no benefit in morbidity when compared to delayed surgery. However, in the literature, early timing refers to cholecystectomy performed up to 96 h of admission or up to 1 week of the onset of symptoms. Considering the natural history of acute cholecystitis, the analysis based on such a range of early timings may have missed a potential advantage that could be hypothesized with an early timing of cholecystectomy limited to the initial phase of the disease. The review aimed to explore the hypothesis that adopting immediate cholecystectomy performed within 24 h of admission as early timing could reduce post-operative complications when compared to delayed cholecystectomy. Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complication rate after early and delayed cholecystectomy for acute cholecystitis were included. Studies were grouped based on the timing of cholecystectomy. The hypothesis that immediate cholecystectomy performed within 24 h of admission could reduce post-operative complications was explored by comparing early timing of cholecystectomy performed within and 24 h of admission and early timing of cholecystectomy performed over 24 h of admission both to delayed timing of cholecystectomy within a sub-group analysis. The literature finding allowed the performance of a second analysis in which early timing of cholecystectomy did not refer to admission but to the onset of symptoms. Results Immediate cholecystectomy performed within 24 h of admission did not prove to reduce post-operative complications with relative risk (RR) of 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, cholecystectomy performed within 72 h of symptoms was found to significantly reduce post-operative complications compared to delayed cholecystectomy with RR = 0.60 [95% CI 0.39;0.92]. Conclusion The present study failed to confirm the hypothesis that immediate cholecystectomy performed within 24 h of admission may reduce post- operative complications unless surgery could be performed within 72 h of the onset of symptoms.

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An evaluation of early and delayed laparoscopic cholecystectomy for acute cholecystitis

Cited by 3 publications

References 16 publications

Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.

Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.

Preoperative Evaluation and Management of Acute Cholecystitis: Optimal Timing and Surgical Approach

Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials

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