Comparison of Clinical Outcome, Safety and Feasibility of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

Abstract

Background: There is ongoing debate on the best time to do a laparoscopic cholecystectomy in cases of acute calculous cholecystitis. While delayed treatment allows acute inflammation to go away, early surgery may shorten hospital stays and prevent recurrent gallstone-related problems. The purpose of this study was to evaluate the safety, practicality, and clinical results of early versus delayed laparoscopic cholecystectomy.

Methods: A prospective, randomized comparative study was conducted in the Department of General Surgery, KIMS Medical College, Bhubaneswar, Odisha, from March 2021 to March 2022. Fifty patients diagnosed with acute calculous cholecystitis were randomly allocated into two groups: early laparoscopic cholecystectomy (ELC, n=25), performed within 72 hours of symptom onset, and delayed laparoscopic cholecystectomy (DLC, n=25), performed six weeks after initial conservative management. Intraoperative parameters, postoperative complications, duration of surgery and hospital stay were compared. Statistical significance was set at p<0.05.

Results: The mean operative duration was significantly longer in the ELC group compared to the DLC group (68.48 ± 20.04 versus 57.36 ± 14.09 minutes; p=0.026). The conversion rate was 8% in the ELC group and 4% in the DLC group (p=1.000). Bile or stone spillage occurred in 20% and 16% of patients, respectively (p=1.000). No common bile duct injuries or postoperative complications were recorded in either group. The mean postoperative hospital stay was comparable (1.72 ± 0.98 versus 1.44 ± 0.65 days; p=0.240). However, the total hospital stay was significantly shorter in the ELC group (2.72 ± 0.98 versus 4.04 ± 0.68 days; p<0.001).

Conclusion: Early laparoscopic cholecystectomy performed within 72 hours is a safe and feasible treatment option for uncomplicated acute calculous cholecystitis. It considerably lowers overall hospital stays without raising conversion rates or surgical problems, even if the procedure takes longer.