Laparoscopic Cholecystectomy in Acute Cholecystitis: Refining the Best Surgical Timing Through Network Meta-Analysis of Randomized Trials

Background:Acute cholecystitis (AC) is largely diffused among population worldwide. Laparoscopic cholecystectomy is the treatment of choice. Current evidence suggests a clinical benefit of early cholecystectomy. The aim of the present study was to evaluate the different timing (early vs. delayed cholecystectomy), through the application of network meta-analyses, to define the most adequate interval associated with the best outcomes. Materials and methods:A network meta-analysis of randomized controlled trials was conducted. Results:Early cholecystectomy <= 72 hours from symptoms reduced conversion rate in comparison to: cholecystectomy <= 7 days from symptoms (P=0.044), delayed cholecystectomy within 1 to 5 weeks from first admission (P=0.010) and 6 to 12 weeks from symptoms resolutions (P=0.009). Delaying cholecystectomy to 6 to 12 weeks reduces operating time in respect to early cholecystectomy <= 72 hours from symptoms (P=0.001), within 24 hours from admission (P=0.001), <= 72 hours from admission (P=0.001) and <= 7 days from symptoms (P=0.001). Cholecystectomy <= 24 hours from admission was the best strategy to reduce total in-hospital stay, whereas delaying cholecystectomy to 6 to 12 weeks was the worst strategy. The same applied when cholecystectomy was performed <= 72 hours from symptoms in respect to both delayed strategies (P=0.001 for both comparisons) or when it was performed <= 72 hours from admission (P=0.001 for both comparisons). Cholecystectomy <= 72 hours from symptoms onset was the best strategy to reduce postoperative complications, the worst was represented by delayed cholecystectomy at 1 to 5 weeks from first admission. Conclusion:AC should be operated as soon as possible. AC surgical management should be considered in a dynamic time conception to optimize clinical, organizational, and economical outcomes.

Automated summary

This study conducted a network meta-analysis to evaluate the timing of cholecystectomy in acute cholecystitis. The results showed that early cholecystectomy within 72 hours from symptoms onset had the lowest conversion rate and reduced postoperative complications. Delaying cholecystectomy to 6 to 12 weeks reduced operating time but increased total in-hospital stay.