Comparative Analysis of Complications in Early Verses Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

TL;DR

This study compares early and delayed laparoscopic cholecystectomy for acute cholecystitis and finds that early surgery leads to fewer complications and shorter hospital stays.

Contribution

The study provides new evidence supporting early laparoscopic cholecystectomy as a better treatment strategy for acute cholecystitis.

Findings

Early laparoscopic cholecystectomy is associated with fewer complications compared to delayed surgery.

Patients undergoing early surgery had shorter hospital stays and fewer readmissions.

Symptom duration was shorter in the early surgery group.

Abstract

Background: Acute cholecystitis (AC) is one of the most frequent gastrointestinal emergencies, necessitating prompt definitive treatment. Laparoscopic cholecystectomy (LC) has become the gold standard for management, although the timing of surgery remains controversial. Early laparoscopic cholecystectomy (ELC) is performed within 72 hours of symptom onset, while delayed laparoscopic cholecystectomy (DLC) is undertaken after a period of conservative management. The purpose of this study is to assess the complications and outcomes of early vs delayed laparoscopic cholecystectomy in patients with acute cholecystitis.

Objectives: To evaluate perioperative outcomes, including complications, operative time, conversion rates, and hospital stay, between patients undergoing early vs delayed laparoscopic cholecystectomy for acute cholecystitis.

Material and methods: This prospective non-randomized comparative study was conducted in the surgical department of Hayatabad Medical Complex (HMC), Peshawar. The study was carried out during a 15-month period, from June 1, 2023, to August 30, 2024. A total of 118 individuals with acute cholecystitis, age ranged between 18 to 60 years, were included. Acute cholecystitis was diagnosed based on imaging examinations, laboratory tests, and the patient's history.

Results: In Group 1, the mean age of patients was 42.5±10.3 years, and it was 44.1±9.8 years in Group 2. Gender distribution was similar in both groups, with a slight predominance of females (Group 1: 35 females, 25 males; Group 2: 34 females, 24 males). In Group 1, the most common presenting symptoms were right upper quadrant pain (55, 92.4%), nausea (47, 78.8%), and fever (27, 45.8%). Similarly, in Group 2, these symptoms were reported in 53 (91.4%), 46 (79.3%), and 27 (46.6%) patients, respectively. Duration of symptoms prior to surgery was 3.2±1.1 days in Group 1 and 4.1±1.3 days in Group 2.

Conclusions: In comparison to delayed laparoscopic cholecystectomy, early laparoscopic cholecystectomy is associated with fewer complications, fewer readmissions, and shorter hospital stays. These findings have led to the recommendation of early intervention as the best strategy for treating acute cholecystitis.