Comparison of early and interval laparoscopic cholecystectomy for treatment of acute cholecystitis. Which is better? A multicentered study

Abstract

Introduction: The aim of this study was to compare early laparoscopic cholecystectomy (LC) and LCs performed at different time intervals for treatment of acute cholecystitis, contribute to the literature with data obtained from different centers, and provide assistance to clinicians about the timing of LC in acute cholecystitis. Materials and Methods: The study was designed as a retrospective, observational, and multicentered study. The data of 470 patients who had undergone LC for treatment of acute cholecystitis between January 2010 and March 2016 were included. Four different centers contributed to the study. The patients were divided into 4 groups. The groups were identified according to the timing of LC following the onset of findings and symptoms of acute cholecystitis as group 1 (first week), group 2 (1 to 4 wk), group 3 (4 to 8 wk), and group 4 (> 8 wk). The clinical and demographical characteristics, comorbidities, complications, hospital stay, duration of operation, conversion rates, and rehospitalizations in the following 30 days of patients in the groups were compared. Results: A significant increase was found in group 4 compared with groups 1 and 2 in relation to comorbidities (P < 0.01) (P= 0.042). No statistically significant difference was observed among the groups for the comparison of operation durations, conversion rates, and total number of complications (P > 0.05). The groups were compared with regard to the mean hospital stay, and the hospital stay was found to be significantly higher in group 4 than in group 1 (P= 0.001). In our study, the 30-day readmission rate was determined to be significantly higher in the > 8-week group (group 4) compared with the first-week (group 1) and 1- to 4-week group (group 2) (P < 0.05). Conclusions: Interval LC does not decrease the complication rate, conversion rate, or the operation time. Early LC could be preferred for treatment of acute cholecystitis as no significant differences related to the conversion rate, operation time, and overall complication rate are observed between the early and delayed LCs; however, a shorter hospital stay and lower 30-day readmission rate are observed in early LC for the treatment of acute cholecystitis.