Kolla SB, Aggarwal S, Kumar A, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial

Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Surgical Endoscopy (Impact Factor: 3.26). 10/2004; 18(9):1323-7. DOI: 10.1007/s00464-003-9230-6
Source: PubMed


The role of laparoscopic cholecystectomy for acute cholecystitis is not yet clearly established. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy.
Between January 2001 and November 2002, 40 patients with a diagnosis of acute cholecystitis were assigned randomly to early laparoscopic cholecystectomy within 24 h of admission (early group, n = 20) or to initial conservative treatment followed by delayed laparoscopic cholecystectomy, 6 to 12 weeks later (delayed group, n = 20).
There was no significant difference in the conversion rates (early, 25% vs delayed, 25%), operating times (early, 104 min vs delayed, 93 min), postoperative analgesia requirements (early, 5.3 days vs delayed, 4.8 days), or postoperative complications (early, 15% vs delayed, 20%). However, the early group had significantly more blood loss (228 vs 114 ml) and shorter hospital stay (4.1 vs 10.1 days).
Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72 to 96 h of the onset of symptoms.

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Available from: Surendra B Kolla
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    • "Several randomized clinical trials of comparisons of early laparoscopic cholecystectomy (ELC, performed within 7 days of onset of symptoms) with delayed laparoscopic cholecystectomy (DLC, performed at least 6 weeks after symptoms occurred) show that ELC could get more benefits in hospital stay and equally the same level of clinical safety, comparing with DLC [9, 10, 12–15]. However, the sample size was not big in previous clinical trials; recently Gutt et al. [7] performed a multicenter randomized controlled trial with a total of 618 patients (304 ELC, 314 DLC). "
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    ABSTRACT: Objective. To compare the clinical safety and outcomes of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for acute cholecystitis. Methods. Pertinent studies were selected from the Medline, EMBASE, and Cochrane library databases, references from published articles, and reviews. Seven randomized controlled trials (early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy) were selected. Conventional meta-analysis according to Cochrane Collaboration was used for the pooling of the results. Results. Seven trials with 1106 patients were included. There was no significant difference between the two groups in terms of bile duct injury (Peto odds ratio 0.49 (95% confidence interval 0.05 to 4.72); P = 0.54) or conversion to open cholecystectomy (risk ratio 0.91 (95% confidence interval 0.69 to 1.20); P = 0.50). The total hospital stay was shorter by 4 days for early laparoscopic cholecystectomy (mean difference −4.12 (95% confidence interval −5.22 to −3.03) days; P < 0.00001). Conclusion. Early laparoscopic cholecystectomy during acute cholecystitis is safe and shortens the total hospital stay.
    Full-text · Article · Jul 2014
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    • "In the early years of laparoscopic surgery, acute cholecystitis was considered a relative contraindication to LC. Recently, it has been shown that LC is feasible and safe for acute cholecystitis [10]. The LC for acute cholecystitis may still be associated with higher rate of morbidity and conversion to laparotomy. "
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    ABSTRACT: Introduction: Although all studies have reported that laparoscopic cholecystectomy (LC) is a safe and effective treatment for acute cholecystitis, the optimal timing for the procedure is still the subject of some debate. Aim: This retrospective analysis of a prospective database was aimed at comparing early with delayed LC for acute cholecystitis. Material and methods: The LC was performed in 165 patients, of whom 83 were operated within 72 h of admission (group 1) and 82 patients after 72 h (group 2) with acute cholecystitis between January 2012 and August 2013. All data were collected prospectively and both groups compared in terms of age, sex, fever, white blood count count, ultrasound findings, operation time, conversion to open surgery, complications and mean hospital stay. Results: The study included 165 patients, 53 men and 112 women, who had median age 54 (20–85) years. The overall conversion rate was 27.9%. There was no significant difference in conversion rates (21% vs. 34%) between groups (p = 0.08). The operation time (116 min vs. 102 min, p = 0.02) was significantly increased in group 1. The complication rates (9% vs. 18%, p = 0.03) and total hospital stay (3.8 days vs. 7.9 days, p = 0.001) were significantly reduced in group 1. Conclusions: Early LC within 72 h of admission reduces complications and hospital stay and is the preferred approach for acute cholecystitis. keywords: acute cholecystitis, laparoscopic cholecystectomy, postoperative complications
    Full-text · Article · Mar 2014 · Przegląd Gastroenterologiczny
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    • "A combined total of 375 patients were included. OR: Odds ratio WMD: Weighted mean difference RCTs included: Johansson et al. 3 – 2003 Kolla et al. 4 – 2004 Lai et al. 5 – 1998 Lo et al. 6 – 1998 Meta-analysis (Level 1 evidence) Mortality Complication rate Conversion rate Operating time f Total hospital stay f Postoperative hospital stay f Bile leak Bile duct injury Early versus delayed group None reported "
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether early laparoscopic cholecystectomy (ELC) in patients presenting with a short history of acute cholecystitis provides better post-operative outcomes than a delayed laparoscopic cholecystectomy (DLC). A total of 92 papers were found using the reported searches of which 10 represented the best evidence; 3 meta-analyses, 4 randomized control trials, 1 prospective controlled study and 2 retrospective cohort studies were included. The authors, date, journal, study type, population, main outcome measures and results were tabulated. No significant difference in complication or conversion rates were shown between the ELC and the DLC group, in the meta-analyses of Gurusamy et al, Lau et al and Siddiqui et al. The ELC group had a decreased hospital stay whereas the DLC group presented a considerable risk for subsequent emergency surgery during the interval period, with a high rate of conversion to open cholecystectomy. All three meta-analyses were based on the randomized control trials of Lo et al, Lai et al, Kolla et al and Johansson et al; the results of each study are summarized. We conclude that there is strong evidence that early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality. The operating time in ELC can be longer, however the incidence of serious complications (i.e. common bile duct injury), is comparable to the DLC group. Larger randomized studies are required before solid conclusions are reached.
    Full-text · Article · Apr 2012 · International Journal of Surgery (London, England)
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