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ORIGINAL ARTICLE
Early and Delayed Laparoscopic Cholecystectomy in Acute

Calculus Cholecystitis: A Prospective Randomized-comparative

Study

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Shyam Lal , Rahul Rohitaj , Md Najim , Manisha Dua , Vinod K Singh , Sumit Chakravarti 6
AbstrAct
Background: Acute cholecystitis is a very common gastrosurgical emergency. The timing of laparoscopic cholecystectomy (LC) in cases of
acute cholecystitis is still a matter of debate. In general, delayed LC is preferred because of higher morbidity and conversion rate when LC is
performed in acute cholecystitis.
Aim and objective: To compare the various parameters and outcomes between early and delayed laparoscopic cholecystectomies with safety
and feasibility evaluation.
Materials and methods: A prospective, randomized controlled, interventional study was conducted from October 2017 to February 2019.
Patients with a diagnosis of acute cholecystitis post-randomization were assigned into the early group (n = 50; LC within 72 hours of admission)
and the delayed group (n = 50; initial conservative treatment followed by delayed LC 6–12 weeks later). The primary outcome measures were
intraoperative and postoperative complications (bile duct injuries, bile leak, and wound infection), morbidity, mortality conversion, and length
of hospital stay. The secondary outcome measures were the mean duration of surgery, the mean blood loss, other complications (subhepatic
collection, postoperative pneumonia), and unsuccessful nonoperative management.
Results: In our study, the conversion rate in early laparoscopic cholecystectomy (ELC) group was 5 (10%) and delayed laparoscopic cholecystectomy
(DLC) group was 7 (14%), respectively. The mean operative time was 77.30 ± 20.078 vs 66.94 ± 29.501 minutes; p <0.001 in ELC and DLC groups,
respectively; the mean blood loss was 82.60 ± 59.67 vs 65.40 ± 74.21; p <0.007 in ELC and DLC groups, respectively. Postoperative complication
was 4 (8%) vs 7 (14%) for ELC and DLC groups, respectively. However, the patients in the ELC group had a significantly shorter hospital stay
(4.46 ± 1.32 vs 6.0 ± 2.54 days; p <0.002).
Conclusion: Early cholecystectomy is safe and feasible in patients with acute cholecystitis. Early cholecystectomy offers definitive treatment
as it eliminates risks of failed conservative management and repeated episodes of acute cholecystitis with the advantage of shorten mean
hospital stay without increased morbidity and mortality.
Keywords: Acute cholecystitis, Cholecystectomy, Early cholecystectomy, Laparoscopic.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1465

IntroductIon 1–6 Department of Surgery, ESI-PGIMSR and Model Hospital, New Delhi,
For symptomatic cholelithiasis, laparoscopic cholecystectomy (LC) India
is a gold standard treatment. The timing of LC in acute calculus Corresponding Author: Shyam Lal, Department of Surgery, ESI-
cholecystitis is still a matter of considerable debate and related PGIMSR and Model Hospital, New Delhi, India, Phone: +91 9811155883,
controversies. Before the laparoscopic era, randomized studies e-mail: slaldr@gmail.com
revealed that the strategy of early open cholecystectomy within How to cite this article: Lal S, Rohitaj R, Najim Md, et al. Early
7 days of the onset of symptoms was preferred as it provided shorter and Delayed Laparoscopic Cholecystectomy in Acute Calculus
hospital stay and reduced potential risk of complications, such as Cholecystitis: A Prospective Randomized-comparative Study. World J
pancreatitis, gangrenous, or emphysematous cholecystitis, without Lap Surg 2021;14(3):149–156.
an increase of postoperative morbidity and mortality. 1,2 Source of support: Nil
Till 1990, acute cholecystitis was considered as a contraindication Conflict of interest: None
for LC due to increased postoperative morbidity, longer operative
3,4
time, and higher conversion rate. Consequently, delayed LC
(DLC) was preferred after conservative medical treatment on the group has reported the significantly shortened hospital stay and
assumption that inflamed tissue is more vulnerable to laparoscopic incurred low cost. 5
intervention and may increase the risk of complications. In the last Despite the evidence, DLC is still preferred in clinical practices
15–20 years, as the surgeons excelled in laparoscopic surgeries, due to controversial timings for LC in cases of acute cholecystitis. 6,7
with improvement in laparoscopic devices and instruments, even The aim of this study was to compare various parameters and
acute cases were considered for LC. Randomized trials and meta- outcomes between ELC and DLC with safety and feasibility evaluation.
analysis have demonstrated that there was no difference in early Outcomes were compared in terms of operative time, intraoperative
LC (ELC) and DLC groups in terms of conversion rate, bile duct and postoperative complications, length of postoperative, and total
injuries, postoperative morbidity, and mortality. Moreover, the ELC hospital stay between ELC and DLC groups.

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