Prospective Evaluation of Early versus Delayed Laparoscopic Cholecystectomy for Treatment of Acute Cholecystitis

Abstract

Although laparoscopic cholecystectomy (LC) is known to be safe in the treatment of acute cholecystitis (AC), the optimal timing of laparoscopic intervention remains controversial. The objective of this study is to prospectively compare the safety and cost effectiveness of early versus delayed LC in AC. Our study population consisted of 43 patients presenting with AC (localized tenderness, white blood cell count >10.0 or temperature >38.0° C, and ultrasound confirmation) who were prospectively randomized to early versus delayed LC during their first admission. Exclusion criteria included a history of peptic ulcer disease or evidence of gallbladder perforation. All patients were treated with bowel rest and antibiotics (piperacillin 2 g intravenous piggyback every 6 hours). Early treatment patients underwent LC as soon as the operating schedule allowed. Delayed treatment patients received anti-inflammatory medication (indomethacin 50 mg per rectum every 12 hours) in addition to bowel rest and antibiotics and underwent operation after resolution of symptoms or within 5 days if symptoms failed to resolve. Early LC was performed in 21 patients, whereas 22 patients underwent delayed LC. There was no difference in age, temperature, or white blood cell count on admission between groups. Early LC slightly reduced operative time and conversion rate. There was no difference in complications. Estimated blood loss was significantly lower in those receiving early LC. There was also a significant reduction in total hospital stay and hospital charges with early LC. We conclude that delay in operation combined with anti-inflammatory medication showed no advantage with regard to operative time, conversion, or complication rate. Furthermore, early laparoscopic intervention significantly reduced operative blood loss, hospital days, and hospital charges.

Incidence of Complications in Early vs. Late Laparoscopic Cholecystectomy after Acute Cholecystitis

“…According to previous research, waiting for an inflammatory gallbladder to cool down causes the surrounding inflammation to mature, resulting in the formation of adhesions that make dissection more difficult. 16 According to some surgeons, edema and hyperemia around the gallbladder in early cholecystitis may assist dissection, 16 and that was evident in our setting. The presence of this edema, along with a thick gall bladder wall, made it easy for us to use the laparoscopic suction device to separate the gall bladder from its bed in most cases.…”

Laparoscopic Cholecystectomy in Acute Cholecystitis: Refining the Best Surgical Timing Through Network Meta-Analysis of Randomized Trials

“…Two studies defined early cholecystectomy when surgery was performed “≤7 days from symptoms.”12,14 Five studies defined as early those cholecystectomies performed within 24 hours from admission9,13,16,20,21 and in addition to these, 1 study defined early as within 24 hours from admission but after more than 72 from symptoms onset 23. These 6 studies were termed together as “≤24 hours from admission.” Five studies defined as early those cholecystectomies performed within 72 hours from admission10,11,17,25,26 and were termed as “≤72 hours from admission.” Finally, 7 studies defined early cholecystectomies as those performed within 72 hours from symptoms onset and were consequently termed as “≤72 hours from symptoms” 15,18,19,22,24,27,28. Details are provided in the Table 1.…”

“…23 These 6 studies were termed together as " ≤ 24 hours from admission." Five studies defined as early those cholecystectomies performed within 72 hours from admission 10,11,17,25,26 and were termed as " ≤ 72 hours from admission." Finally, 7 studies defined early cholecystectomies as those performed within 72 hours from symptoms onset and were consequently termed as " ≤ 72 hours from symptoms".…”

“…9,10,[12][13][14][15][17][18][19][20][21][23][24][25][26][27][28] These studies were termed together as "6-12 weeks from resolution." Two studies defined as delayed those cholecystectomies performed > 7 days from admission 11,16 and one study defined as those performed after 72 hours from symptoms. 22 These 2 definitions were grouped as "1-5 weeks from first admission" to contrast with the previous definition of delayed cholecystectomy.…”

Evaluation of early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis: a prospective, randomized study

“…These nonsurgical methods include oral desaturation of stones using ursodeoxycholic acid, contact disintegration, and extracorporeal lithotripsy techniques. The incidence of gallstones increases with age, from 4% in the third decade of life to 27% in the seventh [ 19 ].…”