Is Early Surgery Better for Acute Cholecystitis?

Acute Cholecystitis: Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial

Gutt CN, Encke J, Köninger J, et al
Ann Surg. 2013;258:385-393

Summary

Is early or delayed management the preferred strategy for managing acute cholecystitis? The authors performed a randomized controlled trial in 304 patients who had surgery within 24 hours of hospital admission and 314 patients who had surgery 7-45 days later. Complications occurred significantly less frequently in the group undergoing early surgery (12% vs 34%; P < .001), and mean hospital stay was halved in the early surgery group. Morbidity rates after 75 days tended to be lower in the group with early surgery.

Viewpoint

Acute cholecystitis is one of our most common surgical emergencies. It is nearly always best managed by cholecystectomy, but the timing of surgery has been controversial. Prior studies had been designed to answer this question, but this report, with a clear definition of early surgery (within 24 hours), demonstrated a marked advantage of early surgery with respect to morbidity, length of hospital stay, and cost reduction. This randomized trial provides strong evidence for the superiority of early surgery vs a "watch and wait" approach for the management of acute cholecystitis.

Abstract