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Published in: Surgical Endoscopy 3/2016

01-03-2016

Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case–control studies

Authors: Amy M. Cao, Guy D. Eslick, Michael R. Cox

Published in: Surgical Endoscopy | Issue 3/2016

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Abstract

Background

Since the advent of laparoscopic cholecystectomy (LC) there has been continued debate regarding the management of acute cholecystitis with either early or delayed LC. Nearly all studies have demonstrated that early LC has a significantly shorter total length of hospital stay compared with delayed LC. Although previous randomized controlled trials and meta-analysis have shown clinical outcomes to favour early surgery, clinical practice continues to vary significantly worldwide. In addition, there is much confusion in the optimal timing for early LC with definitions of early varying from 72 h to 7 days. There have been numerous case–control studies investigating the timing of LC in acute cholecystitis. The aim of this paper is to pool the results from all case–control studies to investigate outcomes including mortality rates, complication rates, length of hospital stay and conversion rates to open procedures.

Methods

A search of electronic databases was performed for case–control studies published between 1985–February 2015.

Results

Results from 77 case–control studies showed statistically significant reductions in mortality, complications, bile duct leaks, bile duct injuries, wound infections, conversion rates, length of hospital stay and blood loss associated with early LC. Although LC within the 72-h window is optimal, patients operated after this window still benefit from early surgery compared to delayed surgery. The duration of symptoms in acute cholecystitis should not influence the surgeons’ willingness to operate acutely.

Conclusions

Early LC is clearly superior to delayed LC in acute cholecystitis. The most recent evidence-based practice strongly suggests that early LC should be standard of care in the management of acute cholecystitis.
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Metadata
Title
Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case–control studies
Authors
Amy M. Cao
Guy D. Eslick
Michael R. Cox
Publication date
01-03-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4325-4

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