Early vs. Delayed Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis: A Comparative Analysis of Outcomes and Complications

Authors

  • Vipul Lad Department of General Surgery, SMIMER, Surat, India
  • Jenish Modi Department of General Surgery, SMIMER, Surat, India
  • Parag Godhani Department of General Surgery, SMIMER, Surat, India

DOI:

https://doi.org/10.55489/njmr.150120251013

Keywords:

Laparoscopic Cholecystectomy, Calculous Cholecystitis, Acute, Complications

Abstract

Background: This study compares early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with acute calculous cholecystitis to determine the optimal timing for surgery. The study aims to assess the outcomes, complications, and safety of both approaches.

Methods: A prospective, comparative study was conducted on 94 patients diagnosed with acute calculous cholecystitis. Patients were randomized into two groups: ELC (Group E), performed within 72 hours of symptom onset, and DLC (Group D), performed 6–12 weeks after initial conservative management. Data on demographic characteristics, clinical features, intraoperative findings, and postoperative outcomes were collected and analyzed. Statistical analysis was conducted using SPSS software, with significance set at p <0.05.

Results: ELC was associated with a shorter total hospital stay and reduced complications compared to DLC. However, the Group D showed a higher rate of conversion to open cholecystectomy and longer operative time. Both groups had similar rates of bile duct injuries and postoperative infections. No significant difference was observed in mortality between the two groups.

Conclusion: ELC is a safe and effective approach for acute calculous cholecystitis, offering benefits in reduced hospital stay and complications. DLC, while feasible, may lead to increased operative challenges and longer recovery times.

References

Peters JH, Ellison EC, Innes JT, et al. Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg. 1991;213(1):3-12. DOI: https://doi.org/10.1097/00000658-199101000-00002 PMid:1824674 PMCid:PMC1358303 DOI: https://doi.org/10.1097/00000658-199101000-00002

Glavic Z, Begic L, Simlesa D, Rukavina A. Treatment of acute cholecystitis: a comparison of open vs laparoscopic cholecystectomy. Surg Endosc. 2001;15(4):398-401. DOI: https://doi.org/10.1007/s004640000357 PMid:11727139 DOI: https://doi.org/10.1007/s004640000333

Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Surg Endosc. 2006;20(1):82-87. DOI: https://doi.org/10.1007/s00464-005-0100-2 PMid:16247580 DOI: https://doi.org/10.1007/s00464-005-0100-2

Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, Schelzig H. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013;258(3):385-393. DOI: https://doi.org/10.1097/SLA.0b013e3182a1599b PMid:24022431 DOI: https://doi.org/10.1097/SLA.0b013e3182a1599b

Gurusamy KS, Samraj K. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev. 2006;2006(4). DOI: https://doi.org/10.1002/14651858.CD005440.pub2 PMCid:PMC8407320 DOI: https://doi.org/10.1002/14651858.CD005440.pub2

Siddiqui T, MacDonald A, Chong PS, Jenkins JT. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis of randomized clinical trials. Am J Surg. 2008;195(1):40-47. DOI: https://doi.org/10.1016/j.amjsurg.2007.03.004 PMid:18070735

Gurusamy KS, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010 Feb;97(2):141-50. DOI: https://doi.org/10.1002/bjs.6929 DOI: https://doi.org/10.1002/bjs.6870

Banz V, Gsponer T, Candinas D, Güller U. Population-based analysis of 4113 patients with acute cholecystitis: Defining the optimal time point for laparoscopic cholecystectomy. Ann Surg. 2011 Jul;254(1):81-8. DOI: https://doi.org/10.1097/SLA.0b013e318228d31c PMid:21817893 DOI: https://doi.org/10.1097/SLA.0b013e318228d31c

Sinha R, Sharma N, Joshi M, Sinha M. Management of acute cholecystitis in elderly patients: a comparative study. Asian J Surg. 2020 Jul;43(7):748-753. DOI: https://doi.org/10.1016/j.asjsur.2019.06.004 PMid:31253384 DOI: https://doi.org/10.1016/j.asjsur.2019.06.004

Lo CM, Liu CL, Lai EC, Fan ST, Wong J. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 1996 May;10(5):456-9. DOI: https://doi.org/10.1007/BF00189414 PMid:3139974 DOI: https://doi.org/10.1007/BF00189414

Johner AM, Raytchev E, Drosdeck JM, Waddle C, Pauli EM, Spector SA, et al. Early versus delayed cholecystectomy: A retrospective cohort study. J Surg Res. 2014 Sep;190(1):228-34. DOI: https://doi.org/10.1016/j.jss.2014.03.018 PMid:24721605 DOI: https://doi.org/10.1016/j.jss.2014.03.018

Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995 Jan;180(1):101-25. doi:10.1016/S1072-7515(00)00226-1.

Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998 Oct;351(9107):321-5. DOI: https://doi.org/10.1016/S0140-6736(97)08447-X PMid:9652612 DOI: https://doi.org/10.1016/S0140-6736(97)08447-X

Hunter JG, Savassi-Rocha PR, Queiroz FL, Prieto JC, Teixeira AR. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: A randomized clinical trial. Ann Surg. 2017 Apr;265(4):518-23. DOI: https://doi.org/10.1097/SLA.0000000000001938 PMid:27501174 PMCid:PMC7099196 DOI: https://doi.org/10.1097/SLA.0000000000001938

Riall TS, Zhang D, Townsend CM Jr, Kuo YF, Goodwin JS. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and resource use. Surgery. 2010 Apr;147(4):668-77. DOI: https://doi.org/10.1016/j.surg.2009.10.055 PMid:19958924 DOI: https://doi.org/10.1016/j.jamcollsurg.2009.12.031

Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002 Oct;325(7365):639-43. DOI: https://doi.org/10.1136/bmj.325.7365.639 PMid:12242178 PMCid:PMC1124163 DOI: https://doi.org/10.1136/bmj.325.7365.639

Ambe PC, Weber SA, Wassenberg D. Is early cholecystectomy for acute cholecystitis feasible in rural hospitals? A prospective cohort study. Patient Saf Surg. 2016 Jul;10:17.

Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of biliary complications after laparoscopic cholecystectomy: the Johns Hopkins experience. Ann Surg. 2005 Mar;241(3):434-44. https://doi.org/10.1097/01.sla.0000161029.27410.71 PMid:15849514 PMCid:PMC1357133 DOI: https://doi.org/10.1097/01.sla.0000161029.27410.71

Simopoulos C, Botaitis S, Polychronidis A, Perente S, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc. 2005 Jun;19(7):905-9. DOI: https://doi.org/10.1007/s00464-004-2197-0 PMid:15868267 DOI: https://doi.org/10.1007/s00464-004-2197-0

Al-Mulhim AA. Timing of early laparoscopic cholecystectomy for acute cholecystitis. JSLS. 2008 Oct-Dec;12(4):282-7.

Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am. 2010 Jun;39(2):157-69, vii. DOI: https://doi.org/10.1016/j.gtc.2010.02.003 PMid:20478480 DOI: https://doi.org/10.1016/j.gtc.2010.02.003

Siddiqui T, Jenkins JT, MacDonald A, Chong PS, Lim J. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: A meta-analysis of randomized clinical trials. Am J Surg. 2008 Jan;195(1):40-7. DOI: https://doi.org/10.1016/j.amjsurg.2007.05.041 PMid:18424294 DOI: https://doi.org/10.1016/j.amjsurg.2007.03.004

Halldestam I, Enell EL, Kullman E, Borch K. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg. 2004 Jun;91(6):734-8. DOI: https://doi.org/10.1002/bjs.4531 PMid:14991625 DOI: https://doi.org/10.1002/bjs.4547

Papi C, Catarci M, D'Ambrosio L, Gili L, Koch M, Grassi GB, et al. Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol. 2004 Dec;99(7):147-55. DOI: https://doi.org/10.1046/j.1572-0241.2003.04002.x PMid:14687156 DOI: https://doi.org/10.1046/j.1572-0241.2003.04002.x

Csendes A, Burdiles P, Diaz JC, Maluenda F, Nava O. Risk factors and classification of acute suppurative cholangitis. Br J Surg. 1996 Oct;83(10):1482-5. DOI: https://doi.org/10.1002/bjs.1800831039 PMid:8944469 DOI: https://doi.org/10.1002/bjs.1800831039

Cheruvu CV, Eyre-Brook IA. Consequences of prolonged wait before gallbladder surgery. Ann R Coll Surg Engl. 2002 Jan;84(1):20-2.

Downloads

Published

2025-01-01

How to Cite

Lad, V., Modi, J., & Godhani, P. (2025). Early vs. Delayed Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis: A Comparative Analysis of Outcomes and Complications. National Journal of Medical Research, 15(01), 2–8. https://doi.org/10.55489/njmr.150120251013

Issue

Section

Original Research Articles