A Comparative Evaluation of Early and Interval Laparoscopic Cholecystectomy in the Management of Acute Cholecystitis

Open Access

Abstract

Background: Acute cholecystitis is a prevalent emergency condition with the optimal treatment in controversy, with the conventional method proposing a delay in the operation after the patient undergoes conservative management. This study aimed to determine the postoperative differences in operating in the initial phase and the interval phase in patients with acute cholecystitis. Methods & Materials: This comparative cross-sectional study was carried out in Kushtia Medical College & Hospital, Kushtia, Bangladesgh from January 2023 to February 2024. A total of 50 adult patients within 72 hours of the onset of acute cholecystitis were equally randomized into two groups, A and B. Group A was subjected to early laparoscopic cholecystectomy, whereas Group B was treated conservatively in the first instance, then laparoscopic cholecystectomy after 8-12 weeks. Demographic variables, clinical features, findings on ultrasonography, intraoperative, and postoperative information were assessed employing suitable statistical analyses with 'p' value < 0.05. Results: 50 patients were randomized to early laparoscopic cholecystectomy (n=25) or interval surgery after conservative treatment (n=25). Early surgery required longer operative time (124.6 ± 36.7 vs 94.5 ± 26.4 minutes, p=0.01), with more acute inflammatory operative findings, including pus and pericholecystic collection, leading to more frequent decompression and drain use, while severe adhesions were more common in the interval group (60% vs 20%, p=0.003). Conversion rates (12% vs 20%, p=0.70) and minor postoperative complications were similar, with no major bile duct injury. Histopathology showed predominantly acute disease in the early group and chronic cholecystitis in the interval group. Total hospital stay was significantly shorter with early surgery (6.9 ± 3.5 vs 14.3 ± 9.8 days, p<0.001). Conclusion: Early laparoscopic cholecystectomy is a safe and viable method for acute cholecystitis, providing a substantial benefit in the overall hospital stay duration even with longer surgical time. Equivalence in complications and lower resource consumption suggests that the preferred strategy in qualified patients is early laparoscopic cholecystectomy.