Prolonged Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis
Condition: Acute Cholecystitis
MeSH terms: Cholecystitis; Acalculous Cholecystitis; Cholecystitis, Acute
Study type: Interventional

Summary: 
      Gallbladder stone affects 10-15% of the adult population, and about 15-25% of these patients
      presented with acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is considered the
      treatment of choice for patients with AC, and recent studies suggest that early laparoscopic
      cholecystectomy (ELC) is preferable. However, the optimal time for ELC in AC is still
      controversial.

      Early laparoscopic cholecystectomy (ELC) was advised for patients presented within 72 hours,
      while conservative treatment and planned delayed laparoscopic cholecystectomy (DLC) after six
      weeks was recommended for patients presented after 72 hours. Surgeons almost always encounter
      patients with AC lasting more than 72 hours and these patients consistently refuse
      conservative treatment and postpone for the DLC.
    

Detailed description: 
      Gallbladder stone affects 10-15% of the adult population, and about 15-25% of these patients
      presented with acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is considered the
      treatment of choice for patients with AC, and recent studies suggest that early laparoscopic
      cholecystectomy (ELC) is preferable. However, the optimal time for ELC in AC is still
      controversial.

      Early laparoscopic cholecystectomy (ELC) was advised for patients presented within 72 hours,
      while conservative treatment and planned delayed laparoscopic cholecystectomy (DLC) after six
      weeks was recommended for patients presented after 72 hours. ELC might be associated with a
      significant reduction in morbidity and mortality rates, comparable conversion rates, shorter
      hospital stays, lower costs, and higher patient satisfaction.

      Surgeons almost always encounter patients with AC lasting more than 72 hours and these
      patients consistently refuse conservative treatment and postpone the DLC. Additionally, 15%
      of patients do not respond to the conservative treatment and still need an emergency
      cholecystectomy and another 25% of patients require re-hospitalization for recurrent attacks
      of AC and biliary colic, biliary pancreatitis, cholangitis, and calcular obstructive jaundice
      during the interval waiting for the DLC. Furthermore, DLC has a higher cost and is
      time-consuming.

      Prolonged LC (PLC) for AC after 3 days from onset of symptoms was thought to be more
      technically difficult and dangerous because of altered anatomo-pathology where suppurative
      and subsequently necrotizing cholecystitis develops after edematous cholecystitis during the
      first 2 to 4 days of symptoms, and this may be associated with increased perioperative
      complications and conversion rate. On the contrary, others believed that hyperemia and edema
      may help the dissection. All the studies in the literature focus on the ELC and DLC with
      little data regarding the safety and feasibility of LC for acute cholecystitis beyond 72
      hours of symptoms.

      More clinical trials are needed for the optimal management of acute cholecystitis after 72
      hours of symptoms. The aim of this study was to compare the clinical outcomes of prolonged
      and delayed LC in patients with acute cholecystitis more than 72 hours of symptoms.
    

Intervention name(s): Laparoscopic cholecystectomy
Intervention type(s): Procedure
Intervention description(s): Removal of gallbladder laparoscopically
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment