Early vs. Delayed Cholecystectomy for Acute Cholecystitis

Allan S. Brett, MD

Early surgery is the better choice for patients who aren't critically ill.

Years ago, cholecystectomy often was delayed for weeks in patients with acute cholecystitis; the rationale was that delayed surgery — after antibiotic therapy had reduced inflammation — would be easier and safer than early surgery. More recently, research has suggested that early surgery is in fact preferable. Two new studies shed additional light on this issue.

In a multicenter trial from Germany, 618 patients with acute cholecystitis were randomized to immediate laparoscopic cholecystectomy (≤24 hours after hospital admission) or to antibiotic therapy and delayed surgery (7–45 days after presentation). Critically ill patients and those with perforation or abscess were excluded. During 75 days of follow-up, the immediate-surgery group had significantly fewer complications and less overall morbidity and spent fewer days in the hospital.

Another study was a population-based, retrospective analysis of all patients admitted to Ontario hospitals with acute cholecystitis between 2004 and 2011. Through propensity matching, the researchers compared 7110 patients who underwent early cholecystectomy (≤7 days after presentation) with 7110 who underwent later surgery (median time to surgery, 8 weeks). At 6 months, major bile duct injury was significantly less common in the early-surgery group, and total days of hospitalization were fewer. As in the German study, critically ill patients were excluded.

Citation(s):

Gutt CN et al. Acute cholecystitis: Early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg 2013 Sep; 258:385.

de Mestral C et al. Comparative operative outcomes of early and delayed cholecystectomy for acute cholecystitis: A population-based propensity score analysis. Ann Surg 2014 Jan; 259:10.