In this study, doctors from Rome, Italy, compared early with delayed cholecystectomy for the treatment of acute lithiasic cholecystitis.
The team selected pertinent studies from the Medline, Embase, Cancerlit, HealthSTAR and Cochrane Library databases, references from published articles, and reviews.
From these they included 12 prospective randomized trials.
The team used the rate difference (RD) and the number needed to treat (NNT) as a measure of the therapeutic effect.
The doctors found that the cumulative operative and perioperative mortality and morbidity for open cholecystectomy were 1% and 18%, respectively. For laparoscopic cholecystectomy these values were 0% and 13%, respectively.
The pooled RD for operative complications in early surgery was 1% for open cholecystectomy and 3% for laparoscopic cholecystectomy.
In laparoscopic cholecystectomy the cumulative conversion rate to open cholecystectomy was 22%.
|Hospital stay was significantly shorter in the early surgery group.|
|American Journal of Gastroenterology|
The pooled RD for conversion rate in early laparoscopic cholecystectomy was 8%.
The team determined that the total hospital stay was significantly shorter in the early surgery group (9.6 versus 5.8 days).
They also found that more than 20% of patients referred to delayed surgery fail to respond to conservative management or suffer recurrent cholecystitis in the interval period.
Dr Claudio Papi's team concluded, "Early operation…does not carry a higher risk of mortality and morbidity compared to delayed operation and should be the preferred surgical approach for patients with acute lithiasic cholecystitis"