Journal Article

Impact of Surgical Timing on Outcomes in Patients With Acute Cholecystitis: A Systematic Review

Alluhaida, Albatoul Abdulaziz, Alenezi, Ahmed Tabaan, Alqahtani, Fatimah Mohammed Duleem, Otayf, Mutaz Mohammed, Al Salamah, Fatemah Salem Jaber, Al Yami, Najla Mohammed Hussein, Alharbi, Azzam Khalid, Assiri, Fatima Faya M, Bin Jerais, Sultan A, Tahir E Hayatmohammed, Mohammadbak

2024

Overview

This study aims to conduct a thorough analysis of the existing studies to determine how patients with acute cholecystitis (AC) respond to surgical intervention at different times following their diagnosis. To locate studies that met the inclusion criteria, a thorough computerized search of relevant databases was carried out. A comprehensive search was carried out on PubMed, SCOPUS, Science Direct, Cochrane Library, and Web of Science to locate relevant material. Our data included seven trials with 48,747 patients: 40,955 in the early laparoscopic cholecystectomy (ELC) group and 7,792 in the delayed laparoscopic cholecystectomy (DLC) group. More than half of the participants (27,687, 56.8%) were female. ELC was found to be safe regardless of when symptoms first appeared, challenging previous assumptions that surgery should be delayed during the initial symptomatic period. Mortality rates for ELC were consistently low, ranging from 0% to 3.9% in all groups, while complication rates varied from 3.5% to 12.5% in all groups as well. Although DLC is still considered safe, the likelihood of complications such as bile duct damage and surgical site infections appeared to increase, particularly in patients who underwent surgery more than three days after the diagnosis of cholecystitis. It is important to note that ELC refers to surgery performed within the first three days after diagnosis, while DLC refers to surgery performed after three days. The systematic review reveals that ELC is a secure and successful remedy for sudden cholecystitis, offering superior outcomes compared to DLC. ELC is associated with lower complication rates, reduced hospital stays, and minimal mortality, suggesting it should be the preferred approach in most cases (performing the surgery within the first three days following the diagnosis of AC). While DLC remains a viable option, particularly for certain patient populations, it carries a higher risk of complications and prolonged recovery times.

• Publisher: Springer Nature B.V,Cureus
• Subject: Cholecystectomy / Clinical outcomes / Gallbladder diseases / General Surgery / Laparoscopy / Length of stay / Mortality / Observational studies / Patients / Sociodemographics / Surgery / Systematic review