Authors: Amy M Cao Guy D Eslick Michael R Cox
Publish Date: 2015/07/03
Volume: 30, Issue: 3, Pages: 1172-1182
Abstract
Since the advent of laparoscopic cholecystectomy LC there has been continued debate regarding the management of acute cholecystitis with either early or delayed LC Nearly all studies have demonstrated that early LC has a significantly shorter total length of hospital stay compared with delayed LC Although previous randomized controlled trials and metaanalysis have shown clinical outcomes to favour early surgery clinical practice continues to vary significantly worldwide In addition there is much confusion in the optimal timing for early LC with definitions of early varying from 72 h to 7 days There have been numerous case–control studies investigating the timing of LC in acute cholecystitis The aim of this paper is to pool the results from all case–control studies to investigate outcomes including mortality rates complication rates length of hospital stay and conversion rates to open proceduresResults from 77 case–control studies showed statistically significant reductions in mortality complications bile duct leaks bile duct injuries wound infections conversion rates length of hospital stay and blood loss associated with early LC Although LC within the 72h window is optimal patients operated after this window still benefit from early surgery compared to delayed surgery The duration of symptoms in acute cholecystitis should not influence the surgeons’ willingness to operate acutely
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