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

Abstract

Background: Acute cholecystitis (AC) is largely diffused among population worldwide. Laparoscopic cholecystectomy is the treatment of choice. Current evidence suggests a clinical benefit of early cholecystectomy. The aim of the present study was to evaluate the different "timing" ("early" vs. "delayed" cholecystectomy), through the application of network meta-analyses, to define the most adequate interval associated with the best outcomes. Materials and methods:A network meta-analysis of randomized controlled trials was conducted.

Safe postoperative outcomes following early cholecystectomy for acute calculus cholecystitis regardless of symptom onset

“…A recent meta-analysis of randomized trials has suggested that early cholecystectomy for AC ≤72 hours from symptoms reduces open conversion rates in comparison to cholecystectomy ≤7 days from symptoms (p= 0.044). In addition, cholecystectomy ≤24 hours from admission is the best strategy to reduce total in-hospital stay (12). An ACS-NSQIP review of early cholecystectomy for AC has concluded that cholecystectomy should be performed within two days of hospital admission, which is based on 1.4 times increase in major complications, and 2-times increase in mortality when surgery was delayed to within 3-7 days of hospital admission (16).…”

“…LC performed for AC 72 hours after onset of symptoms is believed to increase the risk of perioperative complications due to the distorted anatomy of the Calot's triangle from inflammatory adhesions secondary to prolonged inflammation. However, in drafting the Tokyo Guidelines (TG18), it was noted that it is often difficult to precisely determine the duration since symptom onset (12,13). There is heterogeneity in the literature with regards to the definition of early surgery including cholecystectomy within 24 hours of hospital admission or symptom onset, within 72 hours since patient admission or symptom onset, or within one week since onset of symptoms (12).…”

“…However, in drafting the Tokyo Guidelines (TG18), it was noted that it is often difficult to precisely determine the duration since symptom onset (12,13). There is heterogeneity in the literature with regards to the definition of early surgery including cholecystectomy within 24 hours of hospital admission or symptom onset, within 72 hours since patient admission or symptom onset, or within one week since onset of symptoms (12). Thus, it remains difficult to ascertain the optimum timing that will reduce postoperative complications, and the length of stay.…”

Analgesic Efficacy of Foot and Hand Massage for Laparoscopic Cholecystectomy: A Meta-Analysis

“…Cholelithiasis has become one of the most common diseases of the gallbladder [1][2][3]. As the development of the technology and biomedical developments, cholecystectomy can be treated with the laparoscopic method [4][5][6][7][8]. However, many patients undergoing laparoscopic cholecystectomy suffer from severe abdominal pain which was caused by surgical manipulation and peritoneal irritation due to CO2 gas dissolved in the abdomen [9][10][11].…”

The Efficacy of Foot Massage for Pain Relief of Laparoscopic Cholecystectomy: A Meta-analysis Study

“…Laparoscopic cholecystectomy is widely used for the treatment of gallbladder stones which is one of the most common digestive diseases worldwide 1–5. However, these patients commonly suffer from postoperative pain due to surgical manipulation, the increase in intra-abdominal pressure and peritonitis caused by bile 6–8.…”