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Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis

A metaanalysis

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Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Early laparoscopic cholecystectomy has been advocated for the management of acute cholecystitis, but little evidence exists to support the superiority of this approach over delayed-interval operation. The current systematic review was undertaken to compare the outcomes and efficacy between early and delayed-interval laparoscopic cholecystectomy for acute cholecystitis in an evidence-based approach using metaanalytical techniques.

Methods

A search of electronic databases, including MEDLINE and EMBASE, was conducted to identify relevant articles published between January 1988 and June 2004. Only randomized or quasi-randomized prospective clinical trials in the English language comparing the outcomes of early and delayed-interval laparoscopic cholecystectomy for acute cholecystitis were recruited. Both qualitative and quantitative statistical analyses were performed. The effect size of outcome parameters was estimated by odds ratio or weighted mean difference where feasible and appropriate.

Results

A total of four clinical trials comprising 504 patients met the inclusion criteria. Failure of conservative treatment requiring emergency cholecystectomy occurred for 43 patients (23%) in the delayed group. Metaanalyses demonstrated a significantly shortened total length of hospital stay in the early group (weighted mean difference, −1.12; 95% confidence interval [CI], −1.42 to −0.99; p < 0.001). Pooled estimates did not show any significant differences between the two approaches in terms of operation time, conversion rate, overall complication rate, incidence of bile leakage, and intraabdominal collection.

Conclusions

The safety and efficacy of early and delayed-interval laparoscopic cholecystectomy for acute cholecystitis were comparable. Because evidence suggested that early laparoscopic cholecystectomy reduced the total length of hospital stay and the risk of readmissions attributable to recurrent acute cholecystitis, it is therefore a more cost-effective approach for the management of acute cholecystitis.

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References

  1. Asoglu O, Ozmen V, Karanlik H, Igci A, Kecer M, Parlak M, Unal ES (2004) Does the complication rate increase in laparoscopic cholecystectomy for acute cholecystitis? J Laparoendosc Adv Surg Tech A 14: 81–86

    Article  PubMed  Google Scholar 

  2. Avrutis O, Friedman SJ, Meshoulm J, Haskel L, Adler S (2000) Safety and success of early laparoscopic cholecystectomy for acute cholecystitis. Surg Laparosc Endosc Percutan Tech 10: 200–207

    Article  PubMed  CAS  Google Scholar 

  3. Bender JS, Duncan MD, Freeswick PD, Harmon JW, Magnuson TH (2002) Increased laparoscopic experience does not lead to improved results with acute cholecystitis. Am J Surg 184: 591–595

    Article  PubMed  Google Scholar 

  4. Bender JS, Zenilman ME (1995) Immediate laparoscopic cholecystectomy as definitive therapy for acute cholecystitis. Surg Endosc 9: 1081–1084

    Article  PubMed  CAS  Google Scholar 

  5. Bhattacharya D, Senapati PS, Hurle R, Ammori BJ (2002) Urgent versus interval laparoscopic cholecystectomy for acute cholecystitis: a comparative study. J Hepatobiliary Pancreat Surg 9: 538–542

    Article  PubMed  Google Scholar 

  6. Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR (2002) Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg 6: 800–805

    Article  PubMed  Google Scholar 

  7. Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S (2000) Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 14: 755–760

    Article  PubMed  CAS  Google Scholar 

  8. Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW (2000) Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 66: 896–900

    PubMed  CAS  Google Scholar 

  9. Cheema S, Brannigan AE, Johnson S, Delaney PV, Grace PA (2003) Timing of laparoscopic cholecystectomy in acute cholecystitis. J Med Sci 172: 128–131

    CAS  Google Scholar 

  10. Cheruvu CV, Eyre-Brook IA (2002) Consequences of prolonged wait before gallbladder surgery. Ann R Coll Surg Engl 84: 20–22

    PubMed  CAS  Google Scholar 

  11. Cuschieri A (1993) Approach to the treatment of acute cholecystitis: open surgical, laparoscopic or endoscopic? Endoscopy 25: 397–398

    Article  PubMed  CAS  Google Scholar 

  12. Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1997) Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 21: 540–545

    Article  PubMed  CAS  Google Scholar 

  13. Garber SM, Korman J, Cosgrove JM, Cohen JR (1997) Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 11: 347–350

    Article  PubMed  CAS  Google Scholar 

  14. Gardner B, Masur R, Fujimoto J (1973) Factors influencing the timing of cholecystectomy in acute cholecystitis. Am J Surg 125: 730–733

    Article  PubMed  CAS  Google Scholar 

  15. Gharaibeh KI, Qasaimeh GR, Al-Heiss H, Ammari F, Bani-Hani K, Al-Jaberi TM, Al-Natour S (2002) Effect of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis. J Laparoendosc Adv Surg Tech A 12: 193–198

    Article  PubMed  Google Scholar 

  16. Hunter JG (1998) Acute cholecystitis revisited: get it while it’s hot. Ann Surg 227: 468–469

    Article  PubMed  CAS  Google Scholar 

  17. Jarvinen HJ, Hastbacka J (1980) Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg 191: 501–505

    Article  PubMed  CAS  Google Scholar 

  18. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003) Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 7: 642–645

    Article  PubMed  Google Scholar 

  19. Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351: 321–325

    Article  PubMed  CAS  Google Scholar 

  20. Koo KP, Thirlby RC (1996) Laparoscopic cholecystectomy in acute cholecystitis: what is the optimal timing for operation? Arch Surg 131: 540–545

    PubMed  CAS  Google Scholar 

  21. Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H (1996) Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg 20: 43–49

    Article  PubMed  CAS  Google Scholar 

  22. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85: 764–767

    Article  PubMed  CAS  Google Scholar 

  23. Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227: 461–467

    Article  PubMed  CAS  Google Scholar 

  24. Mercer SJ, Knight JS, Toh SK, Walters AM, Sadek SA, Somers SS (2004) Implementation of a specialist-led service for the management of acute gallstone disease. Br J Surg 91: 504–508

    Article  PubMed  CAS  Google Scholar 

  25. Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP (2000) Laparoscopic cholecystectomy in acute cholecystitis: a prospective comparative study in patients with acute vs. chronic cholecystitis. Surg Endosc 14: 358–361

    Article  CAS  Google Scholar 

  26. Rattner DW, Ferguson C, Warshaw AL (1993) Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 217: 233–236

    PubMed  CAS  Google Scholar 

  27. Rosen M, Brody F, Ponsky J (2002) Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 184: 254–258

    Article  PubMed  Google Scholar 

  28. Senapati PS, Bhattarcharya D, Harinath G, Ammori BJ (2003) A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann R Coll Surg Engl 85: 306–312

    Article  PubMed  CAS  Google Scholar 

  29. Serralta AS, Bueno JL, Planells MR, Rodero DR (2003) Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. Surg Laparosc Endosc Percutan Tech 13: 71–75

    Article  PubMed  Google Scholar 

  30. Suter M, Meyer A (2001) A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe? Surg Endosc 15: 1187–1192

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This project was partly supported by the Tung Wah Group of the Hospitals Research Fund. The authors acknowledge the kind assistance of Tze-Ching Tan, MD, in editing the manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, and Tung Wah Hospital, Pokfulam Road, Hong Kong SAR, People’s Republic of China

    H. Lau, C. Y. Lo, N. G. Patil & W. K. Yuen

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  1. H. Lau
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  2. C. Y. Lo
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  3. N. G. Patil
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  4. W. K. Yuen
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Corresponding author

Correspondence to H. Lau.

Additional information

Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting, Fort Lauderdale, FL, USA, 13–16 April 2005

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Lau, H., Lo, C.Y., Patil, N.G. et al. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 20, 82–87 (2006). https://doi.org/10.1007/s00464-005-0100-2

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  • DOI: https://doi.org/10.1007/s00464-005-0100-2

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