Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: an up-to-date meta-analysis of randomized controlled trials

Abstract

Background: This study was performed to compare the safety and effectiveness of early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis (AC). Methods: A systematic search was performed of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1 August 1990 to 1 April 2018. Randomized controlled trials comparing ELC versus DLC were included. The primary outcome was bile duct injury (BDI) and bile leakage. The secondary outcomes were wound infection, total complications, conversion to open surgery, operation time, and total hospital stay. The statistical analysis was performed using Review Manager (RevMan) version 5.3 software (Cochrane Informatics and Knowledge Management Department). Results: Fifteen RCTs were included. A meta-analysis showed no significant differences between ELC and DLC in terms of BDI (risk ratio [RR] 0.79; 95% confidence interval [CI] 0.23–2.79; p = 0.72) (in all subgroups of surgery: within 7, 4, and 3 days) (p = 0.22, 0.49, 0.49, respectively) or bile leakage (RR 2.05; 95% CI 0.98–4.31; p = 0.06). No significant differences were found in the rate of wound infection (RR 0.75; 95% CI 0.51–1.11; p = 0.15), total complications (RR 0.90; 95% CI 0.58–1.39; p = 0.63), or conversion to open surgery (RR 0.94; 95% CI 0.74–1.21; p = 0.64). There were no significant differences in the operation time between ELC and DLC (mean difference [MD] = 9.29 min; 95% CI − 0.41 to 18.98; p = 0.06), but ELC was associated with a longer surgery time within 7 days (MD = 16.49 min; 95% CI 2.10–30.88; p = 0.02). The pooled results showed that ELC was associated with a significantly shorter duration of hospital stay (MD = − 3.07 days; 95% CI − 3.98 to − 2.16; p < 0.00001), but with no significantly difference with postoperative hospital stay (MD = 0.45 days; 95% CI − 0.38 to 1.29; p = 0.29). Conclusion: ELC appears as safe and effective as DLC for acute cholecystitis within 7 days from presentation and may shorten the total hospital stay.