Early versus delayed cholecystectomy in acute cholecystitis: a comparative study in a tertiary care hospital

Jamal Uddin Ahmed, Subal Rajbongshi, Najim Hiquemat


Background: For patients with acute cholecystitis the timing of operative intervention has two broad approaches- early cholecystectomy and elective or delayed cholecystectomy. The main advantage of early cholecystectomy is that, it offers a definitive treatment during the same admission and avoids the problem of failed conservative treatment. The present study is an endeavour to discuss and to compare the outcome of management of acute cholecystitis with early and delayed cholecystectomy.

Methods: 100 patients with clinical diagnosis of acute cholecystitis, admitted in the surgical wards of Gauhati Medical College and Hospital during the period of 1st July 2017 to 30th June 2018 were selected for the study. 40 patients underwent early cholecystectomy (within 7 days of onset of symptoms) and 60 patients underwent elective or late cholecystectomy (after a gap of 6-8 weeks from the acute attack).

Results: In the present series the average duration of surgery was 90.37±11.96 minutes in the early group and 65.3±7.83 minutes for the elective group which is found to be statistically significant (p value<0.05). In the early surgery group 8.33% required conversion to open surgery. In the elective surgery group 3.63% required conversion. Wound infection, biliary leakage, bile duct injury, and respiratory tract infection was found to be statistically not significant between the two groups.

Conclusions: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system.


Early cholecystectomy, Laparoscopic cholecystectomy, Delayed cholecystectomy

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Watters CR. Basic techniques of laparoscopic cholecystectomy. In: Pappas TN, Schwartz LB, Eubanks S, eds. Atlas of Laparoscopic Surgery. 2nd edition, Philadelphia: Current Medicine; 1996: 71-77.

Reynolds JW. The first laparoscopic cholecystectomy. J Soc Laparoendosc Surg. 2001;5(1):89.

Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003;7(5):642-5.

Papi C, Catarci M, D'ambrosio L. Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol. 2004;99(1):147-55.

Strasberg SM. Acute calculous cholecystitis. N Engl J Med. 2008;358(26):2804-11.

Gurusamy KS, Junnarkar S, Farouk M, Davidson BR. Cholecystectomy for suspected gallbladder dyskinesia. Cochrane Database Syst Rev. 2009;(1):CD007086.

Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M, et al. Results of the Tokyo consensus meeting Tokyo guidelines. J Hepato-Biliary-Pancreat Surg. 2007;14(1):114.

Miura F, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gouma DJ, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci. 2013;20(1):47-54.

Takada T, Strasberg SM, Solomkin JS. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci. 2013;20(1):1-7.

Overby DW, Apelgren KN, Richardson W, Fanelli R. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc. 2010;24(10):2368-86.

Somasekar K, Shankar P, Foster M, Lewis M. Costs of waiting for gall bladder surgery. Postgrad Med J. 2002;78(925):668-9.

Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc Other Intervent Tech. 2004;18(9):1323-7.

Cameron I, Chadwick C, Phillips J, Johnson A. Acute cholecystitis--room for improvement? Ann Royal Coll Surg England. 2002;84(1):10.

DeCamp PT, Ochsner A, Baffes TG, Bancroft H, Bendel W. Timing in the surgical treatment of acute cholecystitis. Ann Surg. 1952;135(5):734.

Verma S, Agarwal PN, Rajandeep SB, Rajdeep S, Nikhil T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. ISRN Minim Invas Surg. 2013;2013:486107.

Gul R, Dar RA, Sheikh RA, Salroo NA, Matoo AR, Wani SH. Comparison of early and delayed laparoscopic cholecystectomy for acute cholecystitis: experience from a single center. North Am J Med Sci. 2013;5(7):414.

Yadav RP, Adhikary S, Agrawal CS, Bhattarai B, Gupta RK, Ghimire A. A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis. Kathmandu Univ Med J. 2009;7(1):16-20.

Van der Linden W, Sunzel H. Early versus delayed operation for acute cholecystitis: a controlled clinical trial. Am J Surg. 1970;120(1):7-13.

Ahmad I. Cholecystectomy in acute cholecystitis. J Pak Med Assoc. 1992;42(5):112-5.

Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013;258(3):385-93.

Saber A, Hokkam EN. Operative outcome and patient satisfaction in early and delayed laparoscopic cholecystectomy for acute cholecystitis. Minim Invas Surg. 2014;(2014):162643.

Misra M, Khanna S, Khosla A, Berry M, Kapur B. Emergency versus elective cholecystectomy in acute cholecystitis. Japanese J Surg. 1988;18(4):384-9.