Related Experiment Video
Updated: May 8, 2026
The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
Published on: January 31, 2025
Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304)
Carsten N Gutt1, Jens Encke, Jörg Köninger
1Departments of *Surgery and †Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany ‡Department of Surgery, Katharinen Hospital, Stuttgart, Germany; §Department of Surgery, St. Marien Hospital Muelheim, Muelheim ¶Department of Surgery, Bietigheim Hospital, Bietigheim-Bissingen, Germany ‖Department of Surgery, Ketteler Hospital, Offenbach, Germany; Departments of **Surgery I and ††Internal Medicine II, Diakonie Hospital, Schwaebisch Hall, Germany ‡‡Department of Surgery, Rostock University Hospital, Germany §§Department of Internal Medicine, Katharinen Hospital, Stuttgart, Germany; Departments of ¶¶Surgery and ‖‖Gastroenterology, Magdeburg Hospital, Magdeburg, Germany ***Department of Surgery, Bad Cannstatt Hospital, Stuttgart, Germany †††Karlsruhe Hospital, Karlsruhe, Germany; Department of ‡‡‡Internal Medicine, Salem Hospital, Heidelberg, Germany §§§Research and Public Relations, Burscheid, Germany ¶¶¶Department of Surgery, Salem Hospital, Heidelberg, Germany.
Early laparoscopic surgery for acute cholecystitis significantly reduces morbidity and costs compared to delayed surgery. Immediate intervention within 24 hours is recommended for operable patients, improving outcomes and shortening hospital stays.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Trials
Background:
- Acute cholecystitis management remains debated, with no consensus on optimal surgical timing.
- Early surgery versus delayed surgery after antibiotic treatment presents distinct clinical pathways.
Purpose of the Study:
- To compare the efficacy and safety of immediate laparoscopic surgery versus delayed surgery for acute cholecystitis.
- To evaluate morbidity, costs, and length of hospital stay in different surgical timing strategies.
Main Methods:
- A randomized, prospective, open-label trial (ACDC study) compared immediate laparoscopic cholecystectomy (ILC) within 24 hours to delayed laparoscopic cholecystectomy (DLC) after 7-45 days.
- Patients received moxifloxacin for infection. Primary endpoint was relevant morbidity within 75 days.
Main Results:
- Immediate surgery (ILC) showed significantly lower morbidity (11.8% vs 34.4%) compared to delayed surgery (DLC).
- ILC resulted in shorter hospital stays (5.4 vs 10.0 days) and lower total costs (€2919 vs €4262).
- Conversion rates and mortality did not differ significantly between the groups.
Conclusions:
- Laparoscopic cholecystectomy within 24 hours of admission is superior to a conservative antibiotic approach for acute cholecystitis.
- Immediate laparoscopic surgery should be the preferred treatment for operable patients due to reduced morbidity and costs.
Related Concept Videos
01:20Cholecystitis
01:29Chronic Pancreatitis II: Collaborative Care
Assessment: