Controlled clinical trial comparing early with interval cholecystectomy for acute cholecystitis

Abstract

The traditional management of acute cholecystitis is initial conservative treatment with antibiotics followed by elective cholecystectomy. Although early cholecystectomy has often been advocated, there has been only one randomized controlled clinical trial comparing the two methods of treatment. This paper reports the preliminary results of such a trial in which 32 patients have been studied so far. Of the 17 patients managed conservatively, there was a misdiagnosis in 2 (11.8 per cent). In the remaining 15 patients with acute cholecystitis 3 (20 per cent) required urgent operation because of failure of medical treatment. Elective cholecystectomy was not technically difficult. Of the 15 patients treated by early cholecystectomy, there was a misdiagnosis in 1 (6.8 per cent). Surgery was technically difficult in 2 patients but cholecystectomy was possible in all. The former 2 patients required blood transfusion, but in the remainder the estimated blood loss was only slightly more than in the elective group. There was no mortality in either group nor any complication directly attributable to the biliary surgery. The incidence of minor postoperative complications was only slightly greater in those treated by early operation. The length of postoperative stay was similar in both groups but those treated conservatively spent an average of 11 more days in hospital. The preliminary results indicate that those treated by early cholecystectomy spend less time in hospital and avoid the complications of failed conservative treatment without the added risk of increased postoperative mortality and major complications.

Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones

“…The value of cholecystectomy in acute cholecystitis has already been proven in the prelaparoscopic area [76,77] , however, there is one RCT comparing delayed LC vs. observation [71] . Vetrhus et al [78] compared 31 vs. 33 patients with regard to the natural sequel of cholecystitis without surgical treatment.…”

A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK

“…Whilst the majority of patients respond to such treatment approach, up to one-fifth of patients fail to do so and require an urgent cholecystectomy. [7][8][9] Moreover, up to one-quarter of patients who have recovered from acute cholecystitis relapse while awaiting an interval cholecystectomy. 7 In a randomised controlled trial of early versus delayed open cholecystectomy for acute cholecystitis some 25 years ago, Lahtinen and colleagues 7 found early surgery to be safe and associated with significantly shorter operating time, and had avoided the complications of failed medical treatment.…”

Early Versus Delayed Surgery for Acute Cholecystitis

“…The risks of complications such as perforated gallbladder are diminished. 9,10 4. Dissection is easier during the acute stage.…”

“…Less time is spent in the hospital and recovery is more rapid, which means a lower hospital cost and shorter periods of working incapacity. 5,10,12 Two controlled trials, one from Sweden 5 and another from the United Kingdom 10 suggest that mortality and morbidity are more or less similar in both approaches. On balance, therefore, early cholecystectomy is probably more desirable.…”