Early Versus Late Laparoscopic Cholecystectomy for Acute Cholecystitis

Abstract

Objective: To compare outcomes between early and late laparoscopic cholecystectomy (LC) in patients presenting with acute cholecystitis (AC).

Material and methods: This randomized controlled trial was conducted in the Surgical Department of Capital Development Authority Hospital, Islamabad, from 29 October 2019 to 29 April 2020. Patients aged 18–60 years of either gender diagnosed with acute cholecystitis—confirmed on ultrasonography by the presence of gallstones, a positive sonographic Murphy’s sign, gallbladder wall thickening >3 mm, or pericholecystic fluid—were included. Participants were randomly allocated into two groups: Group A (early LC) and Group B (late LC). All patients received standard preoperative and anesthetic management. Surgeries were performed by a single experienced laparoscopic surgeon. Outcomes were assessed in terms of conversion to open surgery, bile leak, and mean hospital stay.

Results: The mean age in the early LC group was 44 ± 10.7 years, compared to 40 ± 11.9 years in the late LC group. In Group A, 40% of patients were male and 60% were female, whereas in Group B, 35% were male and 65% were female. None of the patients in the early LC group required conversion to open surgery, while 9% of patients in the late LC group were converted. Bile leak occurred in 2% (1 patient) of the early LC group compared to 12% (5 patients) in the late LC group. The mean hospital stay was shorter in the early LC group (2 ± 1.29 days) compared to the late LC group (3 ± 2.84 days).

Conclusion: Early laparoscopic cholecystectomy was associated with fewer complications and a shorter hospital stay and appears to be a better treatment option compared to late laparoscopic cholecystectomy in patients with acute cholecystitis.