Is early laparoscopic cholecystectomy for acute cholecystitis preferable to delayed surgery? Best evidence topic (BET)

Christos Skouras, Omar Jarral, Rahul Deshpande, George Zografos, Nagy Habib, Emmanouil Zacharakis*

*Corresponding author for this work

Research output: Contribution to journalLiterature reviewpeer-review

Abstract

A best evidence topic was written according to a structured protocol. The question addressed was whether early laparoscopic cholecystectomy (ELC) in patients presenting with a short history of acute cholecystitis provides better post-operative outcomes than a delayed laparoscopic cholecystectomy (DLC). A total of 92 papers were found using the reported searches of which 10 represented the best evidence; 3 meta-analyses, 4 randomized control trials, 1 prospective controlled study and 2 retrospective cohort studies were included. The authors, date, journal, study type, population, main outcome measures and results were tabulated.

No significant difference in complication or conversion rates were shown between the ELC and the DLC group, in the meta-analyses of Gurusamy et al, Lau et al and Siddiqui et al. The ELC group had a decreased hospital stay whereas the DLC group presented a considerable risk for subsequent emergency surgery during the interval period, with a high rate of conversion to open cholecystectomy. All three meta-analyses were based on the randomized control trials of Lo et al, Lai et al, Kolla et al and Johansson et al; the results of each study are summarized.

We conclude that there is strong evidence that early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality. The operating time in ELC can be longer, however the incidence of serious complications (i.e. common bile duct injury), is comparable to the DLC group. Larger randomized studies are required before solid conclusions are reached. (C) 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)250-258
Number of pages9
JournalInternational Journal of Surgery
Volume10
Issue number5
DOIs
Publication statusPublished - 2012

Keywords / Materials (for Non-textual outputs)

  • Acute cholecystitis
  • Acute gallstone disease
  • Early laparoscopic cholecystectomy
  • Delayed laparoscopic cholecystectomy
  • Best evidence topic
  • RANDOMIZED-TRIAL
  • METAANALYSIS
  • MANAGEMENT

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