Outcomes of Early Compared to Late Interval Cholecystectomy Post-Percutaneous Cholecystostomy in Patients Diagnosed With Acute Cholecystitis: A Systematic Review and Meta-Analysis.

BACKGROUND

Acute cholecystitis is a common surgical emergency. In high-risk patients, percutaneous cholecystostomy (PC) is often used as a temporizing measure before interval cholecystectomy (IC). The optimal timing of IC remains uncertain. This study evaluates outcomes of early versus late IC following PC.

METHODS

PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception to November 2025 for studies comparing early and late IC after PC. Primary outcomes were perioperative complications. Secondary outcomes included intraoperative duration, blood loss, postoperative length of stay (LOS), and catheter-related complications. Subgroup analyses were performed using 1-month and 8-week interval cut-offs.

RESULTS

Twelve retrospective studies comprising 10,328 patients (early n = 8690; late n = 1638) were included. Baseline characteristics were comparable, although BMI was slightly lower in the early IC group (MD -0.26, 95% CI: -0.50, -0.03, p = 0.03). Overall postoperative complications, major perioperative complications, bile duct injury, subtotal cholecystectomy, and mortality were similar between groups. Conversion to open surgery, operative duration, and postoperative LOS were also comparable. Intraoperative blood loss was greater in the early IC group (MD 16.65, 95% CI: 2.24, 31.06, p = 0.02). Early IC was associated with fewer catheter-related complications (RR 0.38, 95% CI: 0.22, 0.66, p = 0.005). Risk ratio analysis suggested increased intra-abdominal abscess in the early IC group; however, risk difference analysis showed only a small absolute increase, indicating limited clinical significance. In subgroup analysis using a 1-month cut-off, early IC was associated with significantly fewer postoperative complications (RR 0.67, 95% CI: 0.56, 0.79, p < 0.00001).

CONCLUSION

Early IC may confer clinical benefit in appropriately selected patients, with fewer postoperative and catheter-related complications despite risk of greater intraoperative blood loss. A 1-month threshold may represent a pragmatic definition of late IC. A risk-stratified approach remains essential, and further prospective studies are warranted.