COMMENTARY

Early vs Delayed Laparoscopic Cholecystectomy

Albert B. Lowenfels, MD

Disclosures

May 25, 2016

Meta-Analysis Comparing Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

Wu XD, Tian X, Liu MM, Wu L, Zhao S, Zhao L
Br J Surg. 2015;102:1302-1313

Summary

Is early or delayed laparoscopic surgery the preferred treatment option for managing acute cholecystitis? The authors performed a meta-analysis based on 16 reports with a total of 809 patients treated with early surgery and 816 patients managed with delayed surgery. Fifteen of the 16 reports were randomized controlled trials.

The results favored early surgery because it reduced time lost from work by 11 days, shortened hospital stay by 11 days, and lowered the wound infection rate. For other variables, such as bile duct injury, bile leakage, conversion to open surgery, or overall complication rate, no significant differences were found.

Viewpoint

This meta-analysis supports the viewpoint of many surgeons who favor early surgery, although there is no clear definition of either "early" or "delayed." As in other reviews, one of the main benefits was reduced time lost from work, because only one rather than two hospitalizations are involved. A potential risk of discharging the patient after the initial acute attack is that the patient may decide to postpone surgery, thereby increasing the risk for a second attack.

One weakness of this and many other meta-analyses is that the findings for several of the study outcomes, such as the length of stay and overall complication rate, differed between the various individual reports. Furthermore, there is no information about patient satisfaction in the comparison of the two procedures. A final factor that needs to be entered into the decision equation is the surgeon's comfort and experience with the two different surgical options.

Abstract

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