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Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
Published on: November 25, 2025
Early versus delayed laparoscopic cholecystectomy for acute cholecystitis
1Royal Free Hospital, Surgery, 291 Greenhaven Drive, Thamesmead, London, UK. kurinchi2k@hotmail.com
The Cochrane Database of Systematic Reviews
|October 21, 2006
Summary
Early laparoscopic cholecystectomy for acute cholecystitis is safe and reduces hospital stays. This approach avoids complications associated with delayed procedures, offering a potentially better patient outcome.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Outcomes Research
Background:
- Gallstones affect 10-15% of Western adults, with 1-4% becoming symptomatic annually.
- Cholecystectomy is typically delayed post-acute cholecystitis due to concerns about surgical risks.
Purpose of the Study:
- To compare early (within 7 days) versus delayed (over 6 weeks) laparoscopic cholecystectomy for acute cholecystitis.
- To evaluate the benefits and harms associated with each timing approach.
Main Methods:
- Systematic review of randomized clinical trials comparing early and delayed laparoscopic cholecystectomy.
- Searched Cochrane Hepato-Biliary Group Register, CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded.
- Analyzed data using fixed-effect and random-effects models, calculating odds ratios (OR) with 95% confidence intervals (CI).
Main Results:
- Five trials with 451 patients showed no significant difference in mortality, bile duct injury, or conversion rates.
- Early laparoscopic cholecystectomy resulted in a shorter total hospital stay (approx. 3 days).
- Delayed surgery led to 17.5% requiring emergency procedures for non-resolving or recurrent cholecystitis, with 45% of those converting to open surgery.
Conclusions:
- Early laparoscopic cholecystectomy during acute cholecystitis appears safe and reduces overall hospital stay.
- Wide confidence intervals due to rare outcomes necessitate further randomized trials.
- The study suggests early intervention may be beneficial despite the need for more research.
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