Comparison In Clinical Safety And Outcomes Of Early Versus Delayed Laparoscopic Cholecystectomy For Acute Cholecystitis:A Meta-analysis

ObjectiveAcute cholecystitis occurs most commonly due to obstruction of the cystic duct with gallstones (cholelithiasis), is among the most common acute abdomen disease in emergency room. Nowadays, Laparoscopic cholecystectomies (LCs) for index admission for acute cholecystitis are now mainly performed after the acute episode occurred, while conservative therapies, usually antibiotics, and delayed LCs are stilled common in many cases. This meta-analysis was performed to compare the clinical safety and outcomes of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for acute cholecystitis.MethodsRandomized controlled trials (RCTs) of adult patients diagnoses with acute cholecystitis with interventions of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy were searched based on databases of The Cochrane Library trials register, MEDLINE (PubMed), EMBASE (Ovid) and Science Citation Index Expanded (Web of Knowledge) between January 1988 to December 2013. Two independent investigators identified all the data from included studies. The primary outcome measure was safety of treatment (postoperative mortality, surgery-related morbidity such as bile duct injury, et al.; complications such as incidence of pancreatitis, recurrence of cholecystitis, conversion to open cholecystectomy). The secondary outcome measures were outcomes of treatment (length of Hospital stay, operation time, quality of life). And Review Manager software (Version 5.2) was used for the meta-analysis in accordance with the recommendations of the Cochrane Collaboration.ResultsSeven trials with 1106 patients were included. There was no significant difference between the two groups in terms of bile duct injury (Peto OR 0.49(95%CI 0.05 to 4.72); P=0.54) or conversion to open cholecystectomy (RR 0.91(95%CI 0.69 to 1.20); P=0.50). The total hospital stay was shorter by 4 days for ELC (mean difference-4.12 days (95 per cent CI-5.22 to-3.03), P<0.00001).ConclusionEarly laparoscopic cholecystectomy during acute cholecystitis is safe and shortens the total hospital stay.