A randomized controlled study on early and delayed laparoscopic cholecystectomy in acute calculus cholecystitis

Abstract

Background: Acute calculus cholecystitis, characterized by inflammation of the gallbladder due to gallstone obstruction, is a common emergency requiring effective management. Laparoscopic cholecystectomy is the gold standard treatment, but optimal timing remains debated. This study evaluates outcomes of early versus delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis.

Methods: A prospective, randomized controlled trial conducted at Srinivas Institute of Medical Sciences, Mangalore, from July 2022 to July 2023. Ninety-six patients diagnosed with acute calculus cholecystitis were randomized into early (surgery within 72 hours) or delayed (surgery after 6-12 weeks) laparoscopic cholecystectomy groups. Outcomes assessed included operative time, hospital stay, intraoperative bleeding, conversion to open surgery and complications.

Results: The early group had significantly longer mean operative time (95.47±11.41 minutes) compared to delayed group (73.69±17.67 minutes, p=0.04) but a shorter hospital stay (5.2±1.40 days vs. 7.8±1.65 days, p=0.04). The early group experienced higher intraoperative bleeding rates (38 (79.16%) versus 26 (54.16%, p˂0.001). Conversion to open surgery 8 (16.66%) versus 3 (6.25%) p=0.156) and bile duct injuries (2 (4.16%) versus 0%, p=0.241) were slightly more frequent in the early group, though not statistically significant.

Conclusions: Early laparoscopic cholecystectomy is associated with longer operative time and higher bleeding rates but offers shorter hospital stay compared to delayed surgery. Both approaches are safe and the choice should be guided by individual patient factors and surgical expertise. Early surgery can be a viable option, potentially reducing hospital length of stay without significantly worsening postoperative outcomes.