Operative Complications and Economic Outcomes in Acute Cholecystitis for Same-Admission vs Delayed Cholecystectomy

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

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00360-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Giuseppe Borzellino ◽

Safi Khuri ◽

Michele Pisano ◽

Subhi Mansour ◽

Niccolò Allievi ◽

...

Keyword(s):

Acute Cholecystitis ◽

Randomized Clinical Trials ◽

Group Analysis ◽

Hospital Length Of Stay ◽

Early Laparoscopic Cholecystectomy ◽

Delayed Cholecystectomy ◽

Operative Complications ◽

Timing Of Cholecystectomy ◽

Early Timing ◽

Post Operative Complications

Abstract Background Early cholecystectomy for acute cholecystitis has proved to reduce hospital length of stay but with no benefit in morbidity when compared to delayed surgery. However, in the literature, early timing refers to cholecystectomy performed up to 96 h of admission or up to 1 week of the onset of symptoms. Considering the natural history of acute cholecystitis, the analysis based on such a range of early timings may have missed a potential advantage that could be hypothesized with an early timing of cholecystectomy limited to the initial phase of the disease. The review aimed to explore the hypothesis that adopting immediate cholecystectomy performed within 24 h of admission as early timing could reduce post-operative complications when compared to delayed cholecystectomy. Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complication rate after early and delayed cholecystectomy for acute cholecystitis were included. Studies were grouped based on the timing of cholecystectomy. The hypothesis that immediate cholecystectomy performed within 24 h of admission could reduce post-operative complications was explored by comparing early timing of cholecystectomy performed within and 24 h of admission and early timing of cholecystectomy performed over 24 h of admission both to delayed timing of cholecystectomy within a sub-group analysis. The literature finding allowed the performance of a second analysis in which early timing of cholecystectomy did not refer to admission but to the onset of symptoms. Results Immediate cholecystectomy performed within 24 h of admission did not prove to reduce post-operative complications with relative risk (RR) of 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, cholecystectomy performed within 72 h of symptoms was found to significantly reduce post-operative complications compared to delayed cholecystectomy with RR = 0.60 [95% CI 0.39;0.92]. Conclusion The present study failed to confirm the hypothesis that immediate cholecystectomy performed within 24 h of admission may reduce post- operative complications unless surgery could be performed within 72 h of the onset of symptoms.

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Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

Tropical Doctor ◽

10.1177/00494755211010002 ◽

2021 ◽

pp. 004947552110100

Author(s):

Shamir O Cawich ◽

Avidesh H Mahabir ◽

Sahle Griffith ◽

Patrick FaSiOen ◽

Vijay Naraynsingh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Gold Standard ◽

Standard Treatment ◽

Gallstone Disease ◽

Acute Attack ◽

Early Laparoscopic Cholecystectomy ◽

Delayed Surgery ◽

Delayed Cholecystectomy ◽

Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20203251 ◽

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.

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LAPAROSCOPIC CHOLECYSTECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.02.689 ◽

2013 ◽

Vol 20 (02) ◽

pp. 313-318

Author(s):

MOHAMMAD ADNAN NAZEER ◽

HASAAN IMTIAZ ◽

HARUN MAJID DAR ◽

Zulfiqar Ali ◽

Asma Samreen

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Controlled Trial ◽

Early Laparoscopic Cholecystectomy ◽

Delayed Cholecystectomy ◽

Laparoscopic Cholecystectomy Group ◽

Delayed Laparoscopic Cholecystectomy ◽

Delayed Group ◽

Group 2 ◽

Group 1

Introduction: The role of laparoscopic cholecystectomy in treatment of acute cholecystitis is still controversial. Objective:The objective of this prospective randomized controlled trial was to evaluate the outcomes of early laparoscopic cholecystectomy foracute cholecystitis and to compare the results with delayed cholecystectomy. Setting: Sheikh Zayed Hospital, Lahore. Period: 1st Feb,2012 to 31st July 2012. Materials & Methods: 60 diagnosed patients of acute cholecystitis were randomly allocated to two groups,Group 1 underwent early laparoscopic cholecystectomy (Group 1, n = 30) and Group 2 to initial conservative treatment followed bydelayed laparoscopic cholecystectomy, 6 to 12 weeks later (Group 2 , n = 30). Results: The overall complication rate was 3.3% (01) inearly group and 16.7% (05) in the delayed group. There was no common bile duct injury in both groups. The complications includedwound infection and intraperitoneal collection. Conclusions: According to the results our study we concluded that early laparoscopiccholecystectomy can safely be carried out for acute cholecystitis as the complications for early laparoscopic cholecystectomy are lessas compared to delayed laparoscopic cholecystectomy. Early laparoscopic cholecystectomy has also an edge over delayed because ofsingle hospital stay.

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