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Early cholecystectomy for recurrent versus first-time cholecystitis: nationwide population-based study.
Magnus Edblom1, Lars Enochsson1,2, Hanna Nyström1,3
1Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden.
BJS Open
|February 12, 2026
Summary
Early surgery for recurrent cholecystitis increases complication risks, including bile duct injury and intestinal perforation. Prompt surgical intervention during the first episode of acute cholecystitis is recommended to minimize adverse outcomes.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Gallstone Disease Management
Background:
- Acute cholecystitis, a frequent complication of gallstone disease, often necessitates cholecystectomy.
- Delayed or recurrent episodes increase surgical complexity and patient risk.
- This study evaluates complication rates of early cholecystectomy for recurrent versus first-time acute cholecystitis.
Purpose of the Study:
- To compare the 30-day complication rates associated with early cholecystectomy for recurrent acute cholecystitis versus first-time acute cholecystitis.
- To identify specific complications and risk factors in patients undergoing surgery for recurrent gallstone disease.
Main Methods:
- Retrospective population-based cohort study utilizing the Swedish Registry of Gallstone Surgery (2006-2020).
- Comparison of patients with recurrent cholecystitis (n=3384) versus first-time cholecystitis (n=31541).
- Analysis of 30-day complication rates, including bile duct injury, open surgery, and prolonged procedures, using multivariable logistic regression.
Main Results:
- Recurrent cholecystitis cases showed significantly higher overall complication rates (20.2% vs. 13.8%).
- Increased risks observed for bile duct injury (OR 2.44), intestinal perforation (OR 2.54), prolonged surgery (OR 1.64), and open surgery (OR 1.76) in the recurrent group.
- Patients with recurrent cholecystitis were older and had higher American Society of Anesthesiologists (ASA) grades.
Conclusions:
- Early cholecystectomy for recurrent acute cholecystitis is linked to higher complication rates compared to first-time episodes.
- Findings underscore the importance of timely surgical intervention during the initial presentation of acute cholecystitis.
- Proactive management of gallstone disease may mitigate risks associated with recurrent inflammatory processes and subsequent surgeries.
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