Early Cholecystectomy Is Superior to Delayed Cholecystectomy for Acute Cholecystitis: a Meta-analysis

2015 ◽  
Vol 19 (5) ◽  
pp. 848-857 ◽  
Author(s):  
Amy M. Cao ◽  
Guy D. Eslick ◽  
Michael R. Cox
Keyword(s):  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy

scholarly journals Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: Protocol of a systematic review and meta-analysis of results

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Giuseppe Borzellino ◽  
Safi Khuri ◽  
Michele Pisano ◽  
Subhi Mansour ◽  
Niccolò Allievi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Laparoscopic Cholecystectomy ◽  
Early Intervention ◽  
Conservative Treatment ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Early Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Pooled Data ◽  
Delayed Cholecystectomy

Abstract Background Early laparoscopic cholecystectomy has been adopted as the treatment of choice for acute cholecystitis due to a shorter hospital length of stay and no increased morbidity when compared to delayed cholecystectomy. However, randomised studies and meta-analysis report a wide array of timings of early cholecystectomy, most of them set at 72 h following admission. Setting early cholecystectomy at 72 h or even later may influence analysis due to a shift towards a more balanced comparison. At this time, the rate of resolving acute cholecystitis and the rate of ongoing acute process because of failed conservative treatment could be not so different when compared to those operated with a delayed timing of 6–12 weeks. As a result, randomised comparison with such timing for early cholecystectomy and meta-analysis including such studies may have missed a possible advantage of an early cholecystectomy performed within 24 h of the admission, when conservative treatment failure has less potential effects on morbidity. This review will explore pooled data focused on randomised studies with a set timing of early cholecystectomy as a maximum of 24 h following admission, with the aim of verifying the hypothesis that cholecystectomy within 24 h may report a lower post-operative complication rate compared to a delayed intervention. Methods A systematic review of the literature will identify randomised clinical studies that compared early and delayed cholecystectomy. Pooled data from studies that settled the early intervention within 24 h from admission will be explored and compared in a sub-group analysis with pooled data of studies that settled early intervention as more than 24 h. Discussion This paper will not provide evidence strong enough to change the clinical practice, but in case the hypothesis is verified, it will invite to re-consider the timing of early cholecystectomy and might promote future clinical research focusing on an accurate definition of timing for early cholecystectomy for acute cholecystitis.

scholarly journals Early versus delayed cholecystectomy in acute cholecystitis: a comparative study in a tertiary care hospital

2020 ◽  
Vol 7 (8) ◽  
pp. 2656
Author(s):  
Jamal Uddin Ahmed ◽  
Subal Rajbongshi ◽  
Najim Hiquemat
Keyword(s):  
Acute Cholecystitis ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Definitive Treatment ◽  
P Value ◽  
Care Hospital ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Surgery Group ◽  
Duration Of Surgery

Background: For patients with acute cholecystitis the timing of operative intervention has two broad approaches- early cholecystectomy and elective or delayed cholecystectomy. The main advantage of early cholecystectomy is that, it offers a definitive treatment during the same admission and avoids the problem of failed conservative treatment. The present study is an endeavour to discuss and to compare the outcome of management of acute cholecystitis with early and delayed cholecystectomy.Methods: 100 patients with clinical diagnosis of acute cholecystitis, admitted in the surgical wards of Gauhati Medical College and Hospital during the period of 1st July 2017 to 30th June 2018 were selected for the study. 40 patients underwent early cholecystectomy (within 7 days of onset of symptoms) and 60 patients underwent elective or late cholecystectomy (after a gap of 6-8 weeks from the acute attack).Results: In the present series the average duration of surgery was 90.37±11.96 minutes in the early group and 65.3±7.83 minutes for the elective group which is found to be statistically significant (p value<0.05). In the early surgery group 8.33% required conversion to open surgery. In the elective surgery group 3.63% required conversion. Wound infection, biliary leakage, bile duct injury, and respiratory tract infection was found to be statistically not significant between the two groups.Conclusions: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system.

scholarly journals Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis

HPB Surgery ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Miguel Sánchez-Carrasco ◽  
Juan C. Rodríguez-Sanjuán ◽  
Fernando Martín-Acebes ◽  
Francisco J. Llorca-Díaz ◽  
Manuel Gómez-Fleitas ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Cost Savings ◽  
Direct Costs ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Appropriate Treatment ◽  
Costs Of Treatment ◽  
Hospital Morbidity

Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.

scholarly journals Early Cholecystectomy for Acute Cholecystitis in the Elderly Population: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 34 (5) ◽  
pp. 371-379 ◽  
Author(s):  
Charlotte S. Loozen ◽  
Bert van Ramshorst ◽  
Hjalmar C. van Santvoort ◽  
Djamila Boerma
Keyword(s):  
Systematic Review ◽  
Acute Cholecystitis ◽  
Elderly Population ◽  
Meta Analysis ◽  
The Elderly ◽  
Early Cholecystectomy

scholarly journals Acute cholecystitis - early or delayed cholecystectomy

2002 ◽  
Vol 55 (3-4) ◽  
pp. 135-139 ◽  
Author(s):  
Goran Petakovic ◽  
Milan Korica ◽  
Sava Gavrilovic
Keyword(s):  
Sick Leave ◽  
Acute Cholecystitis ◽  
Late Results ◽  
Chronic Cholecystitis ◽  
Home Treatment ◽  
Endocrine Surgery ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Group I ◽  
Group Ii

Introduction In our population biliary tract diseases are the most frequent surgical entity. If the diagnosis of acute cholecystitis is relatively clear and the time from onset of the disease does not exceed 72 hours, early cholecystectomy is recommended. The aim of i his prospective study was to use certain analytical procedures in order to compare early and late results of early and delayed cholecystectomy. Material and methods 240 patients were divided into two groups: Group 1: patients treated by early cholecystectomy and Group II: patients treated by delayed cholecystectomy. We compared the following: intraoperative findings, postoperative morbidity and mortality complications, average number of patient-days and histopathological changes. Results During the investigated period (1998-1999), 599 (35,95%) patients with acute and 1.067 (64.05%) patients with chronic cholecystitis were treated at the Clinic of Abdominal and Endocrine Surgery of the Clinical Center Novi Sad. Out of 599 patients with acute cholecystitis, 489 (81.63%) patients underwent surgery, whereas 1S0 (18.37%) were treated conservatively. In regard to chronic cholecystitis, 963 (90.25%) patients were surgically treated, and 104 (9.75%) patients were conservatively treated. All patients from Group I were operated within 24-48 hours from onset of the disease or during 24 hours of hospitalization. They were hospitalized due to signs of cholecystitis for the first time, whereas this was the second hospitalization for all patients from Group II, 42?2.3 days after first hospitalization on average. Regarding sick leave in Group I patients it was calculated as follows: hospital days + home treatment and it made 32?3.7 days. In Group II it was calculated as follows: first hospitalization + home treatment + second hospitalization + home treatment making 53?6.7 days. Conclusions The number and type of early and late complications in Group II patients justifies early cholecystectomy; in acute cholecystitis, cholecystectomy should be performed within 24 - 48 hours from the onset of the disease; in regard to late, early cholecyslectomies are characterized by significantly shorter period of recovery and sick leave.

scholarly journals Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy

2021 ◽  
Vol 8 (1) ◽  
pp. e000675
Author(s):  
Bhavani Shankara Bagepally ◽  
Madhumitha Haridoss ◽  
Akhil Sasidharan ◽  
Kayala Venkata Jagadeesh ◽  
Nikhil Kumar Oswal
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Conservative Management ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Biliary Complications ◽  
Number Needed To Treat ◽  
Early Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Risk Ratios

BackgroundThe effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy.AimsTo synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness.DesignWe systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm.ResultsOf the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50–100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25–100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000).ConclusionsEarly cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management.PROSPERO registration number2020 CRD42020192612.

scholarly journals Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.

2020 ◽  
Author(s):  
Giuseppe Borzellino ◽  
Safi Khuri ◽  
Michele Pisano ◽  
Subhi Mansour ◽  
Niccolò Allievi ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Literature Search ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Group Analysis ◽  
Early Laparoscopic Cholecystectomy ◽  
Acute Calculous Cholecystitis ◽  
Delayed Cholecystectomy ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background Early cholecystectomy for acute cholecystitis is reported in the literature to be performed up to 96 hours of admission or up to 1 week of the onset of symptoms. Based on the natural history of acute cholecystitis such timing may have missed some potential benefits that could have been expected by performing cholecystectomy in an earlier phase of the disease. The study aimed to explore the hypothesis that an immediate cholecystectomy performed within 24 hours of admission could reduce post-operative complications when compared with delayed cholecystectomy. Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complications at different timings of cholecystectomy for acute cholecystitis were included. The main outcome was the post-operative complication rate. Studies were grouped based on the timing of cholecystectomy which was defined immediate when performed within 24 hours of admission, early when performed up to 96 hours of admission and delayed when surgery was elective after medical treatment. Pooled data of studies comparing post-operative complications after immediate versus delayed and early versus delayed cholecystectomy were analysed within a sub-group analysis. The literature search finding allowed the performance of a second analysis in which immediate cholecystectomy did not refer to a cholecystectomy performed within 24 hours of admission but within 72 hours of the onset of symptoms. Results Immediate cholecystectomy performed within 24 hours of admission did not prove to reduce post-operative complications with relative risk (RR) 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, immediate cholecystectomy performed within 72 hours of the onset of symptoms was found to reduce post-operative complications compared to delayed cholecystectomy with RR 0.57 [95% CI: 0.37;0.89]. Conclusion The present study did not confirm the hypothesis that immediate cholecystectomy performed within 24 hours of admission may reduce post- operative complications. However, the finding of studies in which timing referred not to admission but to the onset of symptoms, allows to favour immediate cholecystectomy if performed within 72 hours of the onset of symptoms.

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