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Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: an up-to-date meta-analysis of randomized controlled trials

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Abstract

Background

This study was performed to compare the safety and effectiveness of early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis (AC).

Methods

A systematic search was performed of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1 August 1990 to 1 April 2018. Randomized controlled trials comparing ELC versus DLC were included. The primary outcome was bile duct injury (BDI) and bile leakage. The secondary outcomes were wound infection, total complications, conversion to open surgery, operation time, and total hospital stay. The statistical analysis was performed using Review Manager (RevMan) version 5.3 software (Cochrane Informatics and Knowledge Management Department).

Results

Fifteen RCTs were included. A meta-analysis showed no significant differences between ELC and DLC in terms of BDI (risk ratio [RR] 0.79; 95% confidence interval [CI] 0.23–2.79; p = 0.72) (in all subgroups of surgery: within 7, 4, and 3 days) (p = 0.22, 0.49, 0.49, respectively) or bile leakage (RR 2.05; 95% CI 0.98–4.31; p = 0.06). No significant differences were found in the rate of wound infection (RR 0.75; 95% CI 0.51–1.11; p = 0.15), total complications (RR 0.90; 95% CI 0.58–1.39; p = 0.63), or conversion to open surgery (RR 0.94; 95% CI 0.74–1.21; p = 0.64). There were no significant differences in the operation time between ELC and DLC (mean difference [MD] = 9.29 min; 95% CI − 0.41 to 18.98; p = 0.06), but ELC was associated with a longer surgery time within 7 days (MD = 16.49 min; 95% CI 2.10–30.88; p = 0.02). The pooled results showed that ELC was associated with a significantly shorter duration of hospital stay (MD = − 3.07 days; 95% CI − 3.98 to − 2.16; p < 0.00001), but with no significantly difference with postoperative hospital stay (MD = 0.45 days; 95% CI − 0.38 to 1.29; p = 0.29).

Conclusion

ELC appears as safe and effective as DLC for acute cholecystitis within 7 days from presentation and may shorten the total hospital stay.

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Data availability

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References

  1. Wiesen SM, Unger SW, Barkin JS, Edelman DS, Scott JS, Unger HM (1993) Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis. Am J Gastroenterol 88:334–337

    CAS  PubMed  Google Scholar 

  2. Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211

    Article  Google Scholar 

  3. Yamashita Y, Takada T, Hirata K (2006) A survey of the timing and approach to the surgical management of patients with acute cholecystitis in Japanese hospitals. J Hepatobiliary Pancreat Surg 13:409–415

    Article  Google Scholar 

  4. Cameron IC, Chadwick C, Phillips J, Johnson AG (2004) Management of acute cholecystitis in UK hospitals: time for a change. Postgrad Med J 80:292–294

    Article  CAS  Google Scholar 

  5. Gurusamy KS, Koti R, Fusai G, Davidson BR (2013) Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic. Cochrane Database Syst Rev Cd007196

  6. 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  Google Scholar 

  7. Lau JY, Leow CK, Fung TM, Suen BY, Yu LM, Lai PB, Lam YH, Ng EK, Lau WY, Chung SS, Sung JJ (2006) Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients. Gastroenterology 130:96–103

    Article  Google Scholar 

  8. Gutt CN (2013) Acute cholecystitis: primarily conservative or operative approach? Zeitschrift fur alle Gebiete der operativen Medizen 84:185–190

    Article  CAS  Google Scholar 

  9. Song GM, Bian W, Zeng XT, Zhou JG, Luo YQ, Tian X (2016) Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?: evidence from a systematic review of discordant meta-analyses. Medicine (Baltimore) 95: e3835

    Article  CAS  Google Scholar 

  10. Cao AM, Eslick GD, Cox MR (2016) Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc 30:1172–1182

    Article  Google Scholar 

  11. Ohta M, Iwashita Y, Yada K, Ogawa T, Kai S, Ishio T, Shibata K, Matsumoto T, Bandoh T, Kitano S (2012) Operative timing of laparoscopic cholecystectomy for acute cholecystitis in a Japanese institute. JSLS 16:65–70

    Article  Google Scholar 

  12. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N (2016) Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule?: A randomized trial. Ann Surg 264:717–722

    Article  Google Scholar 

  13. Rajcok M, Bak V, Danihel L, Kukucka M, Schnorrer M (2016) Early versus delayed laparoscopic cholecystectomy in treatment of acute cholecystitis. Bratislavske lekarske listy 117:328–331

    CAS  PubMed  Google Scholar 

  14. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Methods G (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  Google Scholar 

  15. Mare LD, Roulin AS,D, Demartines N, Halkic N (2012) Delayed versus early laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized study. HPB 14::130

    Google Scholar 

  16. Faizi KS, Ahmed I, Ahmad H (2013) Comparison of early versus delayed laparoscopic cholecystectomy: choosing the best. Pak J Medical Health Sci 7: 212–215

    Google Scholar 

  17. 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  CAS  Google Scholar 

  18. 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  CAS  Google Scholar 

  19. Gul R, Dar RA, Sheikh RA, Salroo NA, Matoo AR, Wani SH (2013) Comparison of early and delayed laparoscopic cholecystectomy for acute cholecystitis: experience from a single center. N Am J Med Sci 5:414–418

    Article  Google Scholar 

  20. Yadav RP, Adhikary S, Agrawal CS, Bhattarai B, Gupta RK, Ghimire A (2009) A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis. Kathmandu Univ Med J 7:16–20

    Article  CAS  Google Scholar 

  21. Macafee DA, Humes DJ, Bouliotis G, Beckingham IJ, Whynes DK, Lobo DN (2009) Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg 96:1031–1040

    Article  CAS  Google Scholar 

  22. Ozkardes AB, Tokac M, Dumlu EG, Bozkurt B, Ciftci AB, Yetisir F, Kilic M (2014) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study. Int Surg 99:56–61

    Article  Google Scholar 

  23. 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

    CAS  PubMed  Google Scholar 

  24. Gutt CN, Encke J, Koninger J, Harnoss JC, Weigand K, Kipfmuller K, Schunter O, Gotze T, Golling MT, Menges M, Klar E, Feilhauer K, Zoller WG, Ridwelski K, Ackmann S, Baron A, Schon MR, Seitz HK, Daniel D, Stremmel W, Buchler MW (2013) Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg 258:385–393

    Article  Google Scholar 

  25. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V (2004) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 18:1323–1327

    Article  CAS  Google Scholar 

  26. Saber A, Hokkam EN (2014) Operative outcome and patient satisfaction in early and delayed laparoscopic cholecystectomy for acute cholecystitis. Minim Invas Surg 2014:162643

    Google Scholar 

  27. Verma S, Agarwal PN, Bali RS, Singh R, Talwar N (2013) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. ISRN Min Invas Surg 2013::3

    Google Scholar 

  28. Dávila DMC, Picho ML, Albors P, Cardenas F, Fuster E et al (1999) Experience in the treatment (early vs. delayed) of acute cholecystitis via laparoscopy. Cir Esp 66:233

    Google Scholar 

  29. Shaffer EA (2006) Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 20:981–996

    Article  Google Scholar 

  30. 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  CAS  Google Scholar 

  31. Lee AY, Carter JJ, Hochberg MS, Stone AM, Cohen SL, Pachter HL (2008) The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital. Am J Surg 195:467–470

    Article  Google Scholar 

  32. Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, Talamini MA, Pitt HA, Coleman J, Sauter PA, Cameron JL (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 241:786–792; (Discussion 793–785)

    Article  Google Scholar 

  33. Club SS (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324:1073–1078

    Article  Google Scholar 

  34. Bouras G, Burns EM, Howell AM, Bagnall NM, Lee H, Athanasiou T, Darzi A (2014) Systematic review of the impact of surgical harm on quality of life after general and gastrointestinal surgery. Ann Surg 260:975–983

    Article  Google Scholar 

  35. Berci G, Hunter J, Morgenstern L, Arregui M, Brunt M, Carroll B, Edye M, Fermelia D, Ferzli G, Greene F, Petelin J, Phillips E, Ponsky J, Sax H, Schwaitzberg S, Soper N, Swanstrom L, Traverso W (2013) Laparoscopic cholecystectomy: first, do no harm; second, take care of bile duct stones. Surg Endosc 27:1051–1054

    Article  Google Scholar 

  36. Pucher PH, Aggarwal R, Qurashi M, Darzi A (2014) Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg 101:1499–1508

    Article  CAS  Google Scholar 

  37. Tornqvist B, Zheng Z, Ye W, Waage A, Nilsson M (2009) Long-term effects of iatrogenic bile duct injury during cholecystectomy. Clin Gastroenterol Hepatol 7:1013–1018; (quiz 1915)

    Article  Google Scholar 

  38. Soderlund C, Frozanpor F, Linder S (2005) Bile duct injuries at laparoscopic cholecystectomy: a single-institution prospective study. Acute cholecystitis indicates an increased risk. World J Surg 29:987–993

    Article  Google Scholar 

  39. Shikata S, Noguchi Y, Fukui T (2005) Early versus delayed cholecystectomy for acute cholecystitis: a meta-analysis of randomized controlled trials. Surg Today 35:553–560

    Article  Google Scholar 

  40. Lau H, Lo CY, Patil NG, Yuen WK (2006) Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc 20:82–87

    Article  CAS  Google Scholar 

  41. Siddiqui T, MacDonald A, Chong PS, Jenkins JT (2008) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg 195:40–47

    Article  Google Scholar 

  42. Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:141–150

    Article  CAS  Google Scholar 

  43. Skouras C, Jarral O, Deshpande R, Zografos G, Habib N, Zacharakis E (2012) Is early laparoscopic cholecystectomy for acute cholecystitis preferable to delayed surgery? Best evidence topic (BET). Int J Surg 10:250–258

    Article  Google Scholar 

  44. Zhou MW, Gu XD, Xiang JB, Chen ZY (2014) Comparison of clinical safety and outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Sci World J 2014:274516

    Google Scholar 

  45. Cao AM, Eslick GD, Cox MR (2015) Early cholecystectomy is superior to delayed cholecystectomy for acute cholecystitis: a meta-analysis. J Gastrointest Surg 19:848–857

    Article  Google Scholar 

  46. Zafar SN, Obirieze A, Adesibikan B, Cornwell EE III, Fullum TM, Tran DD (2015) Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg 150:129–136

    Article  Google Scholar 

  47. Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Buchler MW, Gomi H, Dervenis C, Windsor JA, Kim SW, de Santibanes E, Padbury R, Chen XP, Chan AC, Fan ST, Jagannath P, Mayumi T, Yoshida M, Miura F, Tsuyuguchi T, Itoi T, Supe AN (2013) TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 20:89–96

    Article  Google Scholar 

  48. Banz V, Gsponer T, Candinas D, Guller U (2011) Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg 254:964–970

    Article  Google Scholar 

  49. Degrate L, Ciravegna AL, Luperto M, Guaglio M, Garancini M, Maternini M, Giordano L, Romano F, Gianotti L, Uggeri F (2013) Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients. Langenbecks Arch Surg 398:1129–1136

    Article  Google Scholar 

  50. Gomes RM, Mehta NT, Varik V, Doctor NH (2013) No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study. Ann Gastroenterol 26:340–345

    PubMed  PubMed Central  Google Scholar 

  51. Zhu B, Zhang Z, Wang Y, Gong K, Lu Y, Zhang N (2012) Comparison of laparoscopic cholecystectomy for acute cholecystitis within and beyond 72 h of symptom onset during emergency admissions. World J Surg 36:2654–2658

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  53. Gurusamy KS, Davidson C, Gluud C, Davidson BR (2013) Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev Cd005440

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Liwen Bianji, Edanz Editing China (http://www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Dongyang People’s Hospital, Dongyang, 322100, Zhejiang, China

    Yunxiao Lyu, Yunxiao Cheng, Bin Wang, Sicong Zhao & Liang Chen

  2. Department of General Surgery, Dongyang People’s Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China

    Yunxiao Lyu

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Yunxiao Lyu, Yunxiao Cheng, Bin Wang, Sicong Zhao, Liang Chen have no conflicts of interest or financial ties to disclose.

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Lyu, Y., Cheng, Y., Wang, B. et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: an up-to-date meta-analysis of randomized controlled trials. Surg Endosc 32, 4728–4741 (2018). https://doi.org/10.1007/s00464-018-6400-0

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