Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective Randomized Trial

Abstract

Introduction. Very few studies demonstrate the feasibility of laparoscopic cholecystectomy for acute cholecystitis. However, most surgeons prefer to delay surgery in the acute phase. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis. Materials and Methods. Between August 2010 and March 2012, 30 patients with a diagnosis of acute cholecystitis underwent early laparoscopic cholecystectomy within 72 h of admission. This study group was compared with a control group of 30 patients of acute cholecystitis, who underwent delayed laparoscopic cholecystectomy after an initial period of conservative treatment. Results. There was no significant difference in the conversion rates (3 early versus 2 delayed), postoperative analgesia requirements, postoperative pain scores, or duration of postoperative stay (1.67 days early versus 1.47 days delayed). However, duration of surgery was significantly more in the early group (65.78 minutes early versus 56.83 minutes delayed). Surgery was abandoned in 2 patients from the early group because of difficult anatomy. No complications and mortality were seen in either group. Conclusions. Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72 h from the onset of symptoms.

Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis

“…. Some 16 studies (reporting 15 RCTs) with a total of 1625 patients (ELC 809, DLC 816) were included in the meta‐analysis. Study characteristics are presented in Table .…”

“…Lo et al 32 Lai et al 31 Dávila et al 33 Khan 34 Johansson et al 35 Kolla et al 37 Yadav et al 39 Gul et al 43 Verma et al 41 Subtotal c Length of hospital stay (days)…”

“…Pooled results showed that ELC was associated with a significantly increased duration of operation (MD 11⋅12 Lo et al 32 Lo et al 32 Lo et al 32 Lai et al 31 Lai et al 31 Lai et al 31 Dávila et al 33 Dávila et al 33 Khan 34 Johansson et al 35 Johansson et al 35 Johansson et al 35 Kolla et al 37 Kolla et al 37 Kolla et al 37 Verma et al 41 Verma et al 41 Verma et al 41 Faizi et al 42 Ozkardes et al 46 Ozkardes et al 46 Ozkardes et al 46 Macafee et al 38 Macafee et al 38 Mare et al 40 Mare et al 40 Yadav et al 39 Gul et al 43 Gul et al 43 Gutt et al 44 Gul et al 43 Gutt et al 44 Saber and Hokkam 45 Saber and Hokkam 45 Relative risk Dávila et al 33 Khan 34 Faizi et al 42 Ozkardes et al 46 Ozkardes et al 46 Mare et al 40 Lo et al 32 Lai et al 31 Johansson et al 35 Kolla et al 37 Verma et al 41 Macafee et al 38 Yadav et al…”

Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

“…Surgical outpatients may be overburdened with a variety of referrals, and unsurprisingly, surgeons who perform high volumes of laparoscopic cholecystectomies have longer wait times for review and subsequent surgery. 23,24 In this study, 391 of the 584 patients proceeded to cholecystectomy. Complications of gallstones, including pancreatitis, cholangitis and choledocholithiasis, may be potentially life threatening.…”

“…Meta-analyses of trials comparing early versus delayed cholecystectomy show no significant differences in rate of conversion to an open procedure (19.7 versus 22.1%) or rate of bile duct injury (0.4 versus 0.9%). 23,24 In this study, 391 of the 584 patients proceeded to cholecystectomy. There were no instances of operative bile duct injury.…”