Comparison of Early Vs Interval Laparoscopic Cholecystectomy for Acute Cholecystitis in Terms of Hospital Stay and Operative Time
DOI:
https://doi.org/10.70749/ijbr.v3i6.1873Keywords:
Acute cholecystitis, Laparoscopic cholecystectomy, early surgery, hospital stay, operative time and postoperative outcomesAbstract
Background: This study evaluates and compares early and interval laparoscopic cholecystectomy in terms of hospital stay, operative time, and secondary outcomes. Methods: This cross-sectional investigation took place at Lady Reading Hospital, Peshawar, between November 2023 and May 2024. A cohort of 375 patients, each presenting with acute cholecystitis, was prospectively allocated into two groups according to surgical timing. The early cohort underwent laparoscopic cholecystectomy within 72 hours of symptom onset, whereas the interval cohort received surgery 4 to 6 weeks later, following an initial period of conservative management. Comprehensive data regarding demographic variables, clinical manifestation, surgical parameters, and postoperative outcomes were systematically recorded. The statistical evaluation was executed with SPSS version 25, and a threshold of p<0.05 was employed to indicate statistical significance. Results: The results demonstrated that early laparoscopic cholecystectomy provided significant advantages. Patients in the early group experienced shorter hospital stays ‘(4 days vs. 6 days, p<0.0001) and reduced operative times (60 minutes vs. 70 minutes, p<0.0001)’. ‘The conversion rate to open surgery was also lower in the early group (10% vs. 15%, p=0.015)’. ‘While rates of complications surgical site infections and bile leaks were comparable between the two groups, early group patients recovered faster, resuming normal activities in 10 days compared to 14 days in the interval group (p<0.0001)’. Additionally, patients in the early group reported higher satisfaction scores (4.5 vs. 4.0 on a 5-point scale, p<0.0001), and treatment costs were significantly lower (5000 PKR vs. 6500 PKR, p<0.0001). Conclusions: These findings underscore the effectiveness of early laparoscopic cholecystectomy in managing acute cholecystitis. The approach not only reduces hospital stay, operative time, and treatment costs but also facilitates quicker recovery and improves patient satisfaction, without increasing the risk of complications. This evidence strongly supports the routine adoption of ‘early laparoscopic cholecystectomy as the preferred treatment approach for eligible patients, aligning with current clinical guidelines’ and enhancing overall healthcare outcomes.
Downloads
References
1. Gallaher JR, Charles A. Acute cholecystitis: a review. Jama. 2022;327(10):965-75.
https://doi.org/10.1001/jama.2022.2350
2. Doherty G, Manktelow M, Skelly B, Gillespie P, Bjourson AJ, Watterson S. The need for standardizing diagnosis, treatment and clinical care of cholecystitis and biliary colic in gallbladder disease. Medicina. 2022;58(3):388.
https://doi.org/10.3390/medicina58030388
3. Virdis F, Podda M, Reccia I, Gallo G, Khan M, Martin M, et al. Laparoscopy and minimally invasive surgery techniques in acute care surgery. Trauma Centers and Acute Care Surgery: A Novel Organizational and Cultural Model. 2021:235-48.
https://doi.org/10.1007/978-3-030-73155-7_19
4. Rather ZM, Majid NA, Islam MN, Mohd RW. Outcome of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for patients with acute cholecystitis. International Surgery Journal. 2020;7(4):1212-7.
https://doi.org/10.18203/2349-2902.isj20201399
5. Korayem IM, Bessa SS, El-Sayes I. Extending the optimal timing for early laparoscopic cholecystectomy among patients presenting with acute calculous cholecystitis. The Egyptian Journal of Surgery. 2023;41(3).
https://doi.org/10.1186/s12893-024-02532-x
6. Piele SM, Preda SD, Pătrașcu Ș, Laskou S, Sapalidis K, Dumitrescu D, et al. Indication and Timing of Cholecystectomy in Acute Biliary Pancreatitis-Systematic Review. Current Health Sciences Journal. 2024;50(1):125.
7. Sah MK, Bhattarai A. Day Care Laparoscopic Cholecystectomy: A Review. Sch J Med Case Rep. 2024;3:292-7.
https://doi.org/10.36347/sjmcr.2024.v12i03.015
8. Yuksekdag S, Bas G, Okan I, Karakelleoglu A, Alimoglu O, Akcakaya A, et al. Timing of laparoscopic cholecystectomy in acute cholecystitis. Nigerian journal of clinical practice. 2021;24(2):156-60.
https://doi.org/10.4103/njcp.njcp_138_20
9. Coccolini F, Solaini L, Binda C, Catena F, Chiarugi M, Fabbri C, et al. Laparoscopic cholecystectomy in acute cholecystitis: Refining the best surgical timing through network meta-analysis of randomized trials. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2022;32(6):755-63.
https://doi.org/10.1097/sle.0000000000001103
10. Lucocq J, Patil P, Scollay J. Acute cholecystitis: Delayed cholecystectomy has lesser perioperative morbidity compared to emergency cholecystectomy. Surgery. 2022;172(1):16-22.
https://doi.org/10.1016/j.surg.2022.03.024
11. Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Bang Foss N, Cooper Z, et al. Guidelines for perioperative care for emergency laparotomy Enhanced Recovery After Surgery (ERAS) Society recommendations: part 1—preoperative: diagnosis, rapid assessment and optimization. World journal of surgery. 2021;45(5):1272-90.
https://doi.org/10.1007/s00268-021-05994-9
12. Rickward J, Hameed I, Ho S, Wijeratne S. Day case laparoscopic cholecystectomy: a review of patient selection factors and identification of potential barriers to same‐day discharge. ANZ Journal of Surgery. 2024.
https://doi.org/10.1111/ans.19241
13. Budiæcã OA, Harosa FMG, Ahmed S, Strugari V, Szanto L-A, Bãlan M, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a single center experience. Chirurgia. 2024;119:44-55.
https://doi.org/10.21614/chirurgia.2024.v.119.i.1.p.44
14. Lof S, Vissers F, Klompmaker S, Berti S, Boggi U, Coratti A, et al. Risk of conversion to open surgery during robotic and laparoscopic pancreatoduodenectomy and effect on outcomes: international propensity score-matched comparison study. British Journal of Surgery. 2021;108(1):80-7.
https://doi.org/10.1093/bjs/znaa026
15. Halpern AL, Friedman C, Torphy RJ, Al-Musawi MH, Mitchell JD, Scott CD, et al. Conversion to open surgery during minimally invasive esophagectomy portends worse short-term outcomes: an analysis of the National Cancer Database. Surgical Endoscopy. 2020;34:3470-8.
https://doi.org/10.1007/s00464-019-07124-y
16. Bundgaard NS, Bohm A, Hansted AK, Skovsen AP. Early laparoscopic cholecystectomy for acute cholecystitis is safe regardless of timing. Langenbeck's Archives of Surgery. 2021;406(7):2367-73.
https://doi.org/10.1007/s00423-021-02229-2
17. Cheng X, Cheng P, Xu P, Hu P, Zhao G, Tao K, et al. Safety and feasibility of prolonged versus early laparoscopic cholecystectomy for acute cholecystitis: a single-center retrospective study. Surgical Endoscopy. 2021;35:2297-305.
https://doi.org/10.1007/s00464-020-07643-z
18. Nechay T, Titkova S, Tyagunov A, Anurov M, Sazhin A. Modified enhanced recovery after surgery protocol in patients with acute cholecystitis: efficacy, safety and feasibility. Multicenter randomized control study. Updates in surgery. 2021;73:1407-17.
https://doi.org/10.1007/s13304-021-01031-5
19. Michael Brunt L, Deziel DJ, Telem DA, Strasberg SM, Aggarwal R, Asbun H, et al. Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surgical endoscopy. 2020;34:2827-55.
https://doi.org/10.1097/sla.0000000000004396
20. Isbell KD, Wei S, Dodwad S-JM, Avritscher EB, Mueck KM, Bernardi K, et al. Impact of early cholecystectomy on the cost of treating mild gallstone pancreatitis: gallstone PANC trial. Journal of the American College of Surgeons. 2021;233(4):517-25. e1.
https://doi.org/10.1016/j.jamcollsurg.2021.06.023
21. Riquelme F, Marinkovic B, Salazar M, Martínez W, Catan F, Uribe-Echevarría S, et al. Early laparoscopic cholecystectomy reduces hospital stay in mild gallstone pancreatitis. A randomized controlled trial. HPB. 2020;22(1):26-33.
https://doi.org/10.1016/j.hpb.2019.05.013
22. Yuan X, Xu B, Wong M, Chen Y, Tang Y, Deng L, et al. The safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy for patients with mild acute biliary pancreatitis: A meta-analysis. The Surgeon. 2021;19(5):287-96.
https://doi.org/10.1016/j.surge.2020.06.014
23. Borzellino G, Khuri S, Pisano M, Mansour S, Allievi N, Ansaloni L, et al. Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials. World Journal of Emergency Surgery. 2021;16:1-12.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
