Evidence-based Reviews in Surgery Early Cholecystectomy for Cholecystitis

Question: What are the clinical outcomes of early versus delayed laparoscopic cholecystectomy (LC) in acute cholecystitis with more than 72 hours of symptoms? Design: A randomized controlled trial. Setting: Single center at the University Hospital of Lausanne, Switzerland. Patients: Eighty-six patients were enrolled in the study that had symptoms of acute cholecystitis lasting more than 72 hours before admission. Intervention: Patients were randomly assigned to early LC or delayed LC. Main Outcome: Primary outcome was overall morbidity following initial diagnosis. Secondary outcomes included total length of stay, duration of antibiotic used, cost, and surgical outcome. Results: Overall morbidity was lower in early laparoscopic cholecystectomy (ELC) [6 (14%) vs 17 (39%) patients, P = 0.015]. Median total length of stay (4 vs 7 days, P < 0.001) and duration of antibiotic therapy (2 vs 10 days, P < 0.001) were shorter in the ELC group. Total hospital costs were lower in ELC (9349(sic) vs 12,361(sic), P = 0.018). Operative time and postoperative complications were similar (91 vs 88 minutes; P = 0.910) and (15% vs 17%; P = 1.000), respectively. Conclusions: ELC for acute cholecystitis even beyond 72 hours of symptoms is safe and associated with less overall morbidity, shorter total hospital stay, and duration of antibiotic therapy, as well as reduced cost compared with delayed cholecystectomy.