The appropriate timing for laparoscopic cholecystectomy in the treatment of acute cholecystitis remains controversial.
More recent evaluation indicates early laparoscopic surgery may be a safe option in acute cholecystitis, although conversion rates may be higher.
No conclusive evidence establishing best practice in terms of clinical benefit exists.
|Total hospital stay was reduced with early cholecystectomy|
|American Journal of Surgery|
Dr Tamim Siddiqui and colleagues from Scotland analyzed all randomized clinical studies published between 1987 and 2006.
The research team compared early versus delayed laparoscopic cholecystectomy for acute cholecystitis, irrespective of language, blinding, or publication status.
Exclusions were quasi-randomized trials, inadequate follow-up description, or allocation concealment.
Endpoints included conversion rates, postoperative complications, total hospital stay, and operation time.
The research team used random and fixed-effect models to aggregate the study endpoints and assess heterogeneity.
The researchers identified 4 studies containing 375 patients.
No significant study heterogeneity or publication bias was found.
The team noted no significant difference between the 2 groups in conversion rates.
The research team observed no difference in postoperative complications between both groups.
Operation time was significantly reduced with delayed cholecystectomy.
The team found the total hospital stay was significantly reduced with early cholecystectomy.
The postoperative stay was significantly reduced in the delayed group.
Dr Siddiqui's team concluded, "These meta-analysis data suggest that early laparoscopic cholecystectomy allows significantly shorter total hospital stay."
"This is at the cost of a significantly longer operation time with no significant differences in conversion rates or complications."