The optimal timing of laparoscopic cholecystectomy for acute cholecystitis according to symptom onset and patient admission: a meta-analysis of randomised controlled trials.

BACKGROUND

Acute cholecystitis (AC) is a common surgical emergency, and laparoscopic cholecystectomy (LC) remains its gold standard treatment. However, the optimal timing of LC, whether early during the index admission or delayed after conservative management, remains debated. Variability in defining "early" surgery, whether based on symptom onset or hospital admission, further complicates the interpretation of existing evidence.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD420251081587). Only randomised controlled trials (RCTs) comparing early laparoscopic cholecystectomy (ELC; index admission) with delayed laparoscopic cholecystectomy (DLC; ≥ 4 weeks after conservative management) in adults with AC were included. Primary outcomes were conversion to open surgery, intraoperative complications, common bile duct (CBD) injury and operative time. Secondary outcomes included postoperative complications, wound infections, bile leaks, intra-abdominal collections, retained CBD stones, total length of hospital stay, postoperative length of hospital stay, and mortality. Subgroup analyses were performed according to definitions of early surgery (≤ 72 h from symptom onset or ≤ 72 h from hospital admission).

RESULTS

Twenty-one RCTs comprising 1731 patients were analysed. ELC significantly reduced total hospital stay (mean difference = - 3.50 days, 95% CI - 4.11 to - 2.90; P < 0.00001). There were no significant differences in conversion to open surgery, CBD injury, operative time, or overall postoperative complications. ELC was associated with a higher incidence of intraoperative complications (RR = 2.10, 95% CI 1.31-3.39; P = 0.002); however, these were predominantly minor technical events and did not translate into increased postoperative complications. Subgroup analyses demonstrated consistent safety irrespective of timing definitions.

CONCLUSIONS

Early laparoscopic cholecystectomy reduces hospital stay without increasing major morbidity or bile duct injury. Defining early surgery relative to hospital admission appears clinically practical and safe, supporting early intervention as the preferred strategy in appropriately resourced settings.