Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

Abstract

Conclusion: ELC during acute cholecystitis appears safe and shortens the total hospital stay.

Early versus Delayed Surgery for Acute Cholecystitis as an Applied Treatment Strategy When Assessed in a Population-Based Cohort

“…The somewhat higher proportion of early laparoscopic procedures that had to be converted to an open procedure is predictable and reflects good clinical judgment. Studies from specialized centers show no major differences in complexity and conversion rates between EC versus DC [9,10,11,12,13,14,15,16]. In the present study, the conversion rate was higher than that reported from specialized centers (tables 2, 3).…”

“…In a recent meta-analysis, Gurusamy et al [9] found that 17.5% of patients in the delayed group underwent emergency surgery during the waiting period due to gallstone-related problems. We observed a cumulative re-admission rate, 1 year after the index admission for AC, of 17.8% in patients treated conservatively and where the DC/DLC strategy was applied.…”

“…In recent decades, evidence has gathered showing that early cholecystectomy (EC) for AC during the acute hospital stay is safe, effective and cost-effective [6,7,8]. Lately, data have emerged from centers with great experience in laparoscopic surgery, that early laparoscopic cholecystectomy (ELC) is an attractive, feasible and safe therapeutic strategy [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. In fact a recent meta-analysis concluded that ELC appears to be safe and reduces total hospital stay [9].…”

Biliary

“…Both meta-analyses found that there were no signifi cant differences in conversion rates to open procedures, incidence of common bile duct injuries, or postoperative complications. Early laparoscopic cholecystectomy is also associated with a shorter hospital length of stay and lower total hospital cost [ 63 ]. It should be noted that in one of the meta-analysis, the incidence of bile leaks was higher in the early cholecystectomy group (3 % vs. 0 %) [ 63 ].…”

“…Early laparoscopic cholecystectomy is also associated with a shorter hospital length of stay and lower total hospital cost [ 63 ]. It should be noted that in one of the meta-analysis, the incidence of bile leaks was higher in the early cholecystectomy group (3 % vs. 0 %) [ 63 ]. Also, due to the small number of total patients in these pooled randomized trials (451), the incidence of common duct injury could easily be over or underrepresented in either group due to the low overall incidence of this complication (0.4-0.6 %) [ 65 ].…”