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Laparoscopic Cholecystectomy for Acute Cholecystitis
Table 8: Comparison the complications of various studies
Overall complications, N (%)
Study Year Study design No. of patients (ELC/DLC) ELC group DLC group p value
Kolla et al. 16 2004 Pros/RCT 20/20 4 (20) 3 (15) 0.456
Gul et al. 17 2013 Pros/RCT 30/30 6 (20) 4 (12) 0.863
8
Gutt et al. 2013 Pros RCT 304/314 43 (14.1) 127 (40.4) <0.001
Ozkardes et al. 32 2014 Pros/RCT 30/30 8 (26.7) 0 (0) 0.002
Agrawal et al. 35 2015 Pros/RCT 50/50 8 (32) 2 (8) 0.353
31
Roulin et al. 2016 Pros/RCT 41/41 6 (14.6) 8 (19.4) 1.000
Kohga et al. 25 2018 Retro 288/177 14 (4.8) 23 (12.9) 0.001
Chhajed et al. 30 2018 Pros/RCT 30/20 1 (3.3) 5 (25) 0.007
Arafa et al. 26 2019 Pros/RCT 74/74 20 (27) 42 (56.7) <0.001
Present study 2019 Pros/RCT 50/50 11 (22) 14 (28) 0.583

median total length of hospital stay was shorter in ELC group 2. Norrby S, Herlin P, Holmin T, et al. Early or delayed cholecystectomy
15
19
by 4 days (p <0.001). Further, Menahem et al. found that the in acute cholecystitis? A clinical trial. Br J Surg 1983;70(3):163–165.
mean total length of hospital stay was 5.4 vs 9.1 days in ELC and DOI: 10.1002/bjs.1800700309.
15
DLC groups, respectively (p <0.001). Repeated admission for 3. Wilson P, Leese T, Morgan WP, et al. Elective laparoscopic
recurrent symptoms and a higher rate of conversion have led to cholecystectomy for “allcomers”. Lancet 1991;338:795–797.
DOI: 10.1016/0140-6736(91)90674-e.
more hospital stays. Studies showed that the total hospital stay 4. Kum CK, Eypasch E, Lefering R, et al. Laparoscopic cholecystectomy
16
was more in DLC group, except in the studies of Kolla et al. and for acute cholecystitis: is it really safe? World J Surg 1996;20(1):43–48.
31
Roulin et al. (Table 7). We found that the mean total hospital stay DOI: 10.1007/s002689900008.
was comparatively less in ELC group as compared to DLC group 5. Macafee DAL, Humes DJ, Bouliotis G, et al. Prospective randomized
for acute cholecystitis (p <0.002). trial using cost–utility analysis of early versus delayed laparoscopic
Studies showed that ELC was more economical and resulted in a cholecystectomy for acute gallbladder disease. Br J Surg
better quality of life. 32–34 This may be due to shorter hospitalization 2008;95(Suppl. 3):35. DOI: 10.1002/bjs.6685.
and devoid of conservative treatment in the ELC group. We are 6. Yamashita Y, Takada T, Hirata K. A survey of the timing and approach
working in the government-funded hospital; the cost of treatment to the surgical management of patients with acute cholecystitis in
Japanese hospitals. J Hepatobiliary Pancreat Surg 2006;13(5):409–415.
was therefore not assessed as it was free. DOI: 10.1007/s00534-005-1088-7.
Moreover, meta-analysis of recent randomized studies points 7. Casillas RA, Yegiyants S, Collins JC. Early laparoscopic cholecystectomy
toward decreased incidence of postoperative wound infection, is the preferred management of acute cholecystitis. Arch Surg
shorten total hospital stay, incurred low cost, increased mean 2008;143(6):533–537. DOI: 10.1001/archsurg.143.6.533.
duration of surgery, patient’s satisfaction, quality of life, and 8. Gutt CN, Encke J, Koninger J, et al. Acute cholecystitis: early versus
decreased lost working days in the ELC group. Furthermore, delayed cholecystectomy, a multicentre randomized trial (ACDC
no differences in bile leakage, bile duct injuries, morbidity, and study, NCT00447304). Ann Surg 2013;258(3):385–393. DOI: 10.1097/
SLA.0b013e3182a1599b.
conversion to open surgery were reported. 22,23,28 9. Shaffer EA. Gallstone disease: epidemiology of gallbladder stone
disease. Best Pract Res Clin Gastroenterol 2006;20(6):981–996. DOI:
conclusIon 10.1016/j.bpg.2006.05.004.
ELC in acute cholecystitis is safe and feasible in comparison to 10. Banz V, Gsponer T, Candinas D, et al. Population-based analysis of 4113
elective cholecystectomies. ELC avoids recurrent symptoms due to patients with acute cholecystitis defining the optimal time-point for
multiple episodes of acute cholecystitis and is a definite treatment laparoscopic cholecystectomy. Ann Surg 2011;254(6):964–970. DOI:
10.1097/SLA.0b013e318228d31c.
for cholecystitis in failed conservative management Moreover, 11. Russo MW, Wei JT, Thiny MT, et al. Digestive and liver diseases
ELC is more advantageous as it provides patients safety and lesser statistics, 2004. Gastroenterology 2004;126(5):1448–1453. DOI:
hospital stay. It has economic benefits due to lesser morbidity and 10.1053/j.gastro.2004.01.025.
mortality. 12. Papi C, Catarci M, D’ambrosio L, et al. Timing of cholecystectomy for
acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol
2004;99(1):147. DOI: 10.1046/j.1572-0241.2003.04002.x.
AcknowledgMent 13. Ambe P, Weber SA, Christ H, et al. Cholecystectomy for acute
Authors gratefully acknowledge the help of Dr Subhajeet Dey, Dir. cholecystitis. How time-critical are the so called “golden 72 hours”?
Professor of Surgery, ESI-PGIMSR and Model Hospital, Basaidarapur, Or better “golden 24 hours” and “silver 25–72 hour”? A case control
New Delhi, in the revision of this manuscript by doing peer review study. World J Emerg Surg 2014;9(1):60. DOI: 10.1186/1749-7922-9-60.
and valuable suggestions. 14. Kerwat D, Zargaran A, Bharamgoudar R, et al. Early laparoscopic
cholecystectomy is more cost-effective than delayed laparoscopic
cholecystectomy in the treatment of acute cholecystitis. Clinicoecon
references Outcomes Res 2018;10:119–125. DOI: 10.2147/CEOR.S149924.
1. Järniven HJ, Hästbacka J. Early cholecystectomy for acute cholecystitis. 15. Menahem B, Mulliri A, Fohlen A, et al. Delayed laparoscopic
A prospective randomized study. Ann Surg 1980;191(4):501–505. cholecystectomy increases the total hospital stay compared to an
DOI: 10.1097/00000658-198004000-00018. early laparoscopic cholecystectomy after acute cholecystitis: an

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