Surgical Management of Acute Cholecystitis: Early versus Delayed Laparoscopic Cholecystectomy
DOI:
https://doi.org/10.46880/jkm.v18i1.5811Abstract
Acute cholecystitis is a common surgical emergency, primarily caused by gallstones blocking the cystic duct. Even though laparoscopic cholecystectomy is universally regarded as the best treatment, the best time for surgery is still a matter of clinical and logistical concern. This narrative review assesses the existing evidence about early versus delayed laparoscopic cholecystectomy. Evidence from studies and guidelines consistently demonstrates suggesting early laparoscopic cholecystectomy yields superior results, including reduced total length of hospital stay and lower rates of recurrent biliary events, without increasing major morbidity, conversion to open surgery, or bile duct injury when conducted in accordance with safe surgical principles. Delayed laparoscopic cholecystectomy is still an option for some patients who are temporarily unsuitable for surgery, have uncontrolled sepsis, need their gallbladder drained, or can't get to the right surgical expert. Consequently, the time of intervention ought to be tailored to the patient's physiology, disease severity, and institutional capacity, rather than conforming to a predetermined temporal threshold. Early laparoscopic cholecystectomy needs to be considered the standard of treatment wherever possible, whereas delayed cholecystectomy management should be confined to meticulously chosen cases.
Keywords: acute cholecystitis; laparoscopic cholecystectomy; early cholecystectomy; delayed cholecystectomy; gallbladder
References
Barka, M., Jarrar, M. S., Sahli, J., Abdessalem, Z. Ben, Hamila, F., & Youssef, S. (2023). Early laparoscopic cholecystectomy for acute cholecystitis: should we operate beyond the first week? Langenbeck’s Archives of Surgery, 408(1). https://doi.org/10.1007/s00423-023-02816-5
Bekki, T., Abe, T., Amano, H., Hanada, K., Kobayashi, T., Noriyuki, T., Ohdan, H., & Nakahara, M. (2021). Validation of the Tokyo guideline 2018 treatment proposal for acute cholecystitis from a single-center retrospective analysis. Asian Journal of Endoscopic Surgery, 14(1). https://doi.org/10.1111/ases.12801
Borzellino, G., Khuri, S., Pisano, M., Mansour, S., Allievi, N., Ansaloni, L., & Kluger, Y. (2021). Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials. World Journal of Emergency Surgery, 16(1), 16. https://doi.org/10.1186/s13017-021-00360-5
Bressan, L., Cimino, M. M., Vaccari, F., Capozzela, E., Biloslavo, A., Porta, M., Bortul, M., & Kurihara, H. (2024). Preoperative Waiting Time Affects the Length of Stay of Patients Treated via Laparoscopic Cholecystectomy in an Acute Care Surgical Setting. Journal of Clinical Medicine, 13(23). https://doi.org/10.3390/JCM13237263
Brunt, L. M., Deziel, D. J., Telem, D. A., Strasberg, S. M., Aggarwal, R., Asbun, H., Bonjer, J., McDonald, M., Alseidi, A., Ujiki, M., Riall, T. S., Hammill, C., Moulton, C.-A., Pucher, P. H., Parks, R. W., Ansari, M. T., Connor, S., Dirks, R. C., Anderson, B., … Stefanidis, D. (2020). Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Annals of Surgery, 272(1), 3–23. https://doi.org/10.1097/SLA.0000000000003791
Bundgaard, N. S., Bohm, A., Hansted, A. K., & Skovsen, A. P. (2021). Early laparoscopic cholecystectomy for acute cholecystitis is safe regardless of timing. Langenbeck’s Archives of Surgery, 406(7). https://doi.org/10.1007/s00423-021-02229-2
Coccolini, F., Solaini, L., Binda, C., Catena, F., Chiarugi, M., Fabbri, C., Ercolani, G., & Cucchetti, A. (2022). Laparoscopic Cholecystectomy in Acute Cholecystitis: Refining the Best Surgical Timing Through Network Meta-Analysis of Randomized Trials. In Surgical Laparoscopy, Endoscopy and Percutaneous Techniques (Vol. 32, Number 6). https://doi.org/10.1097/SLE.0000000000001103
de’Angelis, N., Catena, F., Memeo, R., Coccolini, F., Martínez-Pérez, A., Romeo, O. M., De Simone, B., Di Saverio, S., Brustia, R., Rhaiem, R., Piardi, T., Conticchio, M., Marchegiani, F., Beghdadi, N., Abu-Zidan, F. M., Alikhanov, R., Allard, M.-A., Allievi, N., Amaddeo, G., … Sommacale, D. (2021). 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World Journal of Emergency Surgery, 16(1), 30.
https://doi.org/10.1186/s13017-021-00369-w
Di Martino, M., Mora-Guzmán, I., Jodra, V. V., Dehesa, A. S., García, D. M., Ruiz, R. C., Nisa, F. G. M., Moreno, F. M., Batanero, S. A., Sampedro, J. E. Q., Cumplido, P. L., Bravo, A. A., Rubio-Perez, I., Asensio-Gomez, L., Aranda, F. P., Farrarons, S. S., Moreno, C. R., Moreno, C. M. M., Lasarte, A. S., … Martin-Perez, E. (2021). How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score. Journal of Gastrointestinal Surgery, 25(11). https://doi.org/10.1007/s11605-021-04956-9
Escartín, A., González, M., Pinillos, A., Cuello, E., Muriel, P., Tur, J., Merichal, M., Mestres, N., Mías, M.-C., & Olsina, J.-J. (2019). Failure to perform index cholecystectomy during acute cholecystitis results in significant morbidity for patients who present with recurrence. HPB, 21(7), 876–882. https://doi.org/10.1016/j.hpb.2018.11.007
Gallaher, J. R., & Charles, A. (2022). Acute Cholecystitis. JAMA, 327(10), 965. https://doi.org/10.1001/jama.2022.2350
Gomi, H., Solomkin, J. S., Schlossberg, D., Okamoto, K., Takada, T., Strasberg, S. M., Ukai, T., Endo, I., Iwashita, Y., Hibi, T., Pitt, H. A., Matsunaga, N., Takamori, Y., Umezawa, A., Asai, K., Suzuki, K., Han, H., Hwang, T., Mori, Y., … Yamamoto, M. (2018). Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 3–16. https://doi.org/10.1002/jhbp.518
Kourounis, G., Rooke, Z. C., McGuigan, M., & Georgiades, F. (2022). Systematic review and meta-analysis of early vs late interval laparoscopic cholecystectomy following percutaneous cholecystostomy. HPB : The Official Journal of the International Hepato Pancreato Biliary Association,
(9), 1405–1415. https://doi.org/10.1016/j.hpb.2022.03.016
Lin, Y. N., Wu, Y. T., Fu, C. Y., Liao, C. H., Cheng, C. T., Wang, S. Y., Lin, B. C., Hsu, Y. P., Kang, S. C., Liu, E. H., Kuo, I. M., Ou Yang, C. H., Yang, S. J., Huang, J. F., Hsu, C. P., Hsieh, F. J., Liao, C. A., Kuo, L. W., Tee, Y. S., & Hsieh, C. H. (2021). Evaluating the advantages of treating acute cholecystitis by following the Tokyo Guidelines 2018 (TG18): a study emphasizing clinical outcomes and medical expenditures. Surgical Endoscopy, 35(12). https://doi.org/10.1007/s00464-020-08162-7
Loozen, C. S., Van Santvoort, H. C., Van Duijvendijk, P., Besselink, M. G., Gouma, D. J., Nieuwenhuijzen, G. A., Kelder, J. C., Donkervoort, S. C., Van Geloven, A. A., Kruyt, P. M., Roos, D., Kortram, K., Kornmann, V. N., Pronk, A., Van Der Peet, D. L., Crolla, R. M., Van Ramshorst, B., Bollen, T. L., & Boerma, D. (2018). Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): Multicentre randomised clinical trial. BMJ (Online), 363. https://doi.org/10.1136/bmj.k3965
Lyu, Y., Cheng, Y., Wang, B., Zhao, S., & Chen, L. (2018). Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: an up-to-date meta-analysis of randomized controlled trials. Surgical Endoscopy, 32(12), 4728–4741. https://doi.org/10.1007/s00464-018-6400-0
Mansor, S., Zaidi, A., Habibullah, M., Hourani, R., Aldali, Y., Ghali, M. S., Dawdi, S., Suliman, I., Alobahi, M., Jarboa, L., Valiyapurayil, M., & Zarour, A. (2025). Early Laparoscopic Cholecystectomy for Acute Cholecystitis. When Do Risks Seem Imminent? Asian Journal of Endoscopic Surgery, 18(1). https://doi.org/10.1111/ases.70052
Mencarini, L., Vestito, A., Zagari, R. M., & Montagnani, M. (2024). The Diagnosis and
Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach. Journal of Clinical Medicine, 13(9), 2695. https://doi.org/10.3390/jcm13092695
Miura, F., Okamoto, K., Takada, T., Strasberg, S. M., Asbun, H. J., Pitt, H. A., Gomi, H., Solomkin, J. S., Schlossberg, D., Han, H., Kim, M., Hwang, T., Chen, M., Huang, W. S., Kiriyama, S., Itoi, T., Garden, O. J., Liau, K., Horiguchi, A., … Yamamoto, M. (2018). Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 31–40. https://doi.org/10.1002/jhbp.509
Okamoto, K., Suzuki, K., Takada, T., Strasberg, S. M., Asbun, H. J., Endo, I., Iwashita, Y., Hibi, T., Pitt, H. A., Umezawa, A., Asai, K., Han, H., Hwang, T., Mori, Y., Yoon, Y., Huang, W. S., Belli, G., Dervenis, C., Yokoe, M., … Yamamoto, M. (2018). Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 55–72. https://doi.org/10.1002/jhbp.516
Pisano, M., Allievi, N., Gurusamy, K., Borzellino, G., Cimbanassi, S., Boerna, D., Coccolini, F., Tufo, A., Di Martino, M., Leung, J., Sartelli, M., Ceresoli, M., Maier, R. V., Poiasina, E., De Angelis, N., Magnone, S., Fugazzola, P., Paolillo, C., Coimbra, R., … Ansaloni, L. (2020). 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World Journal of Emergency Surgery, 15(1), 61. https://doi.org/10.1186/s13017-020-00336-x
Rajcok, M., Bak, V., Danihel, L., Kukucka, M., & Schnorrer, M. (2016). Early versus
delayed laparoscopic cholecystectomy in treatment of acute cholecystitis. Bratislava
Medical Journal, 117(6). https://doi.org/10.4149/BLL_2016_065
Ramírez-Giraldo, C., Torres-Cuellar, A., & Van-Londoño, I. (2023). State of the art in subtotal cholecystectomy: An overview. In Frontiers in Surgery (Vol. 10). https://doi.org/10.3389/fsurg.2023.1142579
Rice, C. P., Vaishnavi, K. B., Chao, C., Jupiter, D., Schaeffer, A. B., Jenson, W. R., Griffin, L. W., & Mileski, W. J. (2019). Operative complications and economic outcomes of cholecystectomy for acute cholecystitis. World Journal of Gastroenterology, 25(48), 6916–6927. https://doi.org/10.3748/wjg.v25.i48.6916
Roulin, D., Saadi, A., Di Mare, L., Demartines, N., & Halkic, N. (2016). Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule? A randomized trial. Annals of Surgery, 264(5). https://doi.org/10.1097/SLA.0000000000001886
van Maasakkers, M. H. G., Weijs, T. J., Cnossen, O. P., van Braak, W. G., Kelder, J. C., Roulin, D., & Boerma, D. (2024). Evaluating the 7-day barrier: early laparoscopic cholecystectomy for cholecystitis with prolonged symptom duration; a systematic review and meta-analysis. In Langenbeck’s Archives of Surgery (Vol. 409, Number 1). https://doi.org/10.1007/s00423-024-03555-x
Wakabayashi, G., Iwashita, Y., Hibi, T., Takada, T., Strasberg, S. M., Asbun, H. J., Endo, I., Umezawa, A., Asai, K., Suzuki, K., Mori, Y., Okamoto, K., Pitt, H. A., Han, H. S., Hwang, T. L., Yoon, Y. S., Yoon, D. S., Choi, I. S., Huang, W. S. W., … Yamamoto, M. (2018). Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic
cholecystectomy for acute cholecystitis (with videos). Journal of Hepato-Biliary-
Pancreatic Sciences, 25(1). https://doi.org/10.1002/jhbp.517
Wiggins, T., Markar, S. R., MacKenzie, H., Faiz, O., Mukherjee, D., Khoo, D. E., Purkayastha, S., Beckingham, I., & Hanna, G. B. (2019). Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study. Surgical Endoscopy, 33(8), 2495–2502. https://doi.org/10.1007/s00464-018-6537-x
Wu, H., Liao, B., Cao, T., Ji, T., Huang, J., Luo, Y., & Ma, K. (2023). Comparison of the safety profile, conversion rate and hospitalization duration between early and delayed laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis. In Frontiers in Medicine (Vol. 10). https://doi.org/10.3389/fmed.2023.1185482
Yokoe, M., Hata, J., Takada, T., Strasberg, S. M., Asbun, H. J., Wakabayashi, G., Kozaka, K., Endo, I., Deziel, D. J., Miura, F., Okamoto, K., Hwang, T., Huang, W. S., Ker, C., Chen, M., Han, H., Yoon, Y., Choi, I., Yoon, D., … Yamamoto, M. (2018). Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 41–54. https://doi.org/10.1002/jhbp.515
INDEKS
