Clinical outcomes of early and delayed cholecystectomy for acute gallstone-related disease

Laparoscopic cholecystectomy is the definitive treatment for gallstone-related disease. Early laparoscopic cholecystectomy (ELC) is recommended for management of acute gallstone-related disease, as delayed laparoscopic cholecystectomy (DLC) is associated with recurrent presentations and complications. This series evaluated the outcomes of ELC and DLC in patients presenting acutely to secondary care.

All cholecystectomies performed for patients presenting with acute gallstone-related disease including biliary colic, acute cholecystitis, gallstone pancreatitis and obstructive jaundice over a 24-month period were included. Clinical outcomes including hospital stay, peri-operative complications, re-presentation of gallstone-related disease, and repeat hospital admissions and imaging were recorded for ELC and DLC cases.

Of 105 cholecystectomies performed, only 6.7% were ELC. The mean time from index presentation to cholecystectomy was 3.4 days and 119.6 days for ELC and DLC, respectively. Over one-third of patients (38.8%) undergoing DLC experienced recurrent gallstone-related disease between index presentation and surgery. Re-admission to hospital for gallstone-related symptoms was seen in 25.5% of patients. The mean additional inpatient stay for readmission for gallstone-related disease in the DLC group was 3.3 days, with 30.6% requiring repeat imaging.

DLC is associated with significant recurrence of gallstone-related complications. Re-admission to hospital incurs additional inpatient stay, and investigation, leading to a negative impact on patients' health and additional financial burden.