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A Randomised Controlled Trial Comparing Early versus Interval Laparoscopic Cholecystectomy for Acute Calculous
Anil Kumar1, Shesh Kumar1, Rafey Abdul Rahman2
1Department of General Surgery, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.
Background:
Acute calculous cholecystitis (ACC) is a common surgical emergency. The optimal timing for laparoscopic cholecystectomy (LC) remains controversial.
Aims:
This study compared outcomes between early LC (ELC) and interval LC (ILC) for ACC.
Materials And Methods:
A prospective randomised controlled trial was conducted with 100 patients equally allocated to ELC (within 72 h) or ILC (6-8 weeks post-conservative management). Primary outcomes included operative time, conversion rate and total hospital stay. Secondary outcomes assessed intraoperative events and post-operative complications.
Results:
Mean operative time was significantly longer in the ELC group (95.47 min vs. 73.69 min, P = 0.001). Total hospital stay was shorter with ELC (6.50 days vs. 10.80 days, P = 0.009). Conversion rates were higher in the ILC group (18% vs. 8%, P = 0.245). Bile duct injuries occurred exclusively in the ELC group (8% vs. 0%). Significant intraoperative bleeding (80% vs. 56%) and total postoperative complications (30% vs. 8%, P = 0.006) were more frequent with ELC.
Conclusion:
ELC reduces hospital stay but is associated with longer operative times and higher complication rates. ILC may offer a safer operative field but extends overall treatment duration. Timing should be individualised based on patient factors, surgical expertise and institutional resources, with stringent adherence to safety principles.
