Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case–control studies

Abstract

Early LC is clearly superior to delayed LC in acute cholecystitis. The most recent evidence-based practice strongly suggests that early LC should be standard of care in the management of acute cholecystitis.

Commentary to paper “Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 hours of symptom onset”

“…Consequently, it does not seem to be justified to wait more than 72 h to perform LC in acute cholecystitis; it is, moreover, assertible that in agreement with the paper of Onoe et al [3], an early treatment in suitable patients leads to higher success rate, less adverse events, with shorter hospital stay, and less costs, but with technical and organization efforts. Despite the current evidences, surgical practice varies significantly worldwide, with a range of 11-89% of surgeons performing an early approach; furthermore, it is still maintained the culture that acute cholecystitis is not a surgical emergency [3].…”

“…Similarly, also the operating time was comparable. Interestingly, Onoe et al [2] have identified at univariate analysis C-reactive protein as predictive variable for laparotomic conversion; high CRP values ([10 mg/dl) have been related to the failure to create a critical view of safety, leading to a more accurate surgical strategy choice, in relation to the individual case.Pursuing the topic, a comprehensive meta-analysis by Cao et al [3] demonstrates that these benefits will still present, although on a smaller scale, in the subgroup operated after 72 h, but within 7 days. This suggests that the ''72 h rule'' is an optimal timing; however, patients operated after this window still benefit from an early LC, rather than a non-operative management.…”

“…Pursuing the topic, a comprehensive meta-analysis by Cao et al [3] demonstrates that these benefits will still present, although on a smaller scale, in the subgroup operated after 72 h, but within 7 days. This suggests that the ''72 h rule'' is an optimal timing; however, patients operated after this window still benefit from an early LC, rather than a non-operative management.…”

“…Despite the current evidences, surgical practice varies significantly worldwide, with a range of 11-89% of surgeons performing an early approach; furthermore, it is still maintained the culture that acute cholecystitis is not a surgical emergency [3]. To change the attitude of this challenging pathology, the surgeons should become aware of clearly benefits demonstrated in the commented study and new models need to be developed to improve the management of emergency surgical cases, such as dedicated acute surgical units, overcoming aforementioned drawbacks.…”

Acute calculous cholecystitis: Review of current best practices

“…Cao et al[43] (2015) in their meta-analyses studied if ELC is superior to DLC for ACC management. They showed that ELC group has presented reductions in mortality, bile duct complications and improvement in many other parameters analyzed.…”