Is early laparoscopic cholecystectomy for acute cholecystitis preferable to delayed surgery?: Best evidence topic (BET)

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• 作者：Christos Skouras^a ; Omar Jarral^b ; Rahul Deshpande^c ; George Zografos^d ; Nagy Habib^e ; Emmanouil Zacharakis^f ; ^{e.zacharakis@imperial.ac.uk}
• 关键词：Acute cholecystitis ; Acute gallstone disease ; Early laparoscopic cholecystectomy ; Delayed laparoscopic cholecystectomy ; Best evidence topic
• 刊名：International Journal of Surgery
• 出版年：2012
• 期刊代码：152_17439191
• 类别：med
• 出版时间：2012
• 卷：10
• 期：5
• 页码：250-258
• 文件大小：368 K

摘要

A best evidence topic was written according to a structured protocol. The question addressed was whether early laparoscopic cholecystectomy (ELC) in patients presenting with a short history of acute cholecystitis provides better post-operative outcomes than a delayed laparoscopic cholecystectomy (DLC). A total of 92 papers were found using the reported searches of which 10 represented the best evidence; 3 meta-analyses, 4 randomized control trials, 1 prospective controlled study and 2 retrospective cohort studies were included. The authors, date, journal, study type, population, main outcome measures and results were tabulated.

No significant difference in complication or conversion rates were shown between the ELC and the DLC group, in the meta-analyses of Gurusamy et聽al, Lau et聽al and Siddiqui et聽al. The ELC group had a decreased hospital stay whereas the DLC group presented a considerable risk for subsequent emergency surgery during the interval period, with a high rate of conversion to open cholecystectomy. All three meta-analyses were based on the randomized control trials of Lo et聽al, Lai et聽al, Kolla et聽al and Johansson et聽al; the results of each study are summarized.

We conclude that there is strong evidence that early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality. The operating time in ELC can be longer, however the incidence of serious complications (i.e. common bile duct injury), is comparable to the DLC group. Larger randomized studies are required before solid conclusions are reached.