Early Cholecystectomy for calculous cholecystitis safe, without intraoperative complications

A recent study addressing the optimal timing for Early Cholecystectomy (EC) in patients with acute calculous cholecystitis (ACC) has provided valuable insights into the management of this condition. The study, a multicentric prospective observational research effort, focused on patients with ACC who underwent cholecystectomy within ten days from the onset of symptoms.

The study was published in Healthcare journal by Paola Fugazzola and colleagues. The findings, based on data from 1,117 patients studied over a year, are encouraging and have significant implications for clinical practice. The patients were divided into three groups based on the timing of the cholecystectomy: those who underwent the procedure within 0–3 days, 4–7 days, and 8–10 days from the onset of symptoms.

The study’s primary objective was to determine whether the timing of EC affected various post-operative outcomes. The research did not identify any significant differences in post-operative complications, mortality, conversion rates, and the need for reintervention among the different timing groups.

However, the timing of EC did have a notable impact on intraoperative complications and the rate of subtotal cholecystectomies. Specifically, the study revealed that earlier EC (within 0–3 days) resulted in a lower risk of intraoperative complications (2.8%) compared to patients who had surgery between 4–7 days (5.6%) or 8–10 days (7.9%) after symptom onset.

Moreover, patients who received EC within the first three days had a lower rate of subtotal cholecystectomies (2.7%) than those in the 4–7 days group (5.6%) and the 8–10 days group (10.9%).

These results emphasize the importance of early intervention for ACC. The study suggests that as ACC progresses, the local and systemic inflammation intensifies, rendering surgery more complex and increasing the risk of intraoperative complications. Therefore, the recommendation stemming from this research is clear: performing EC for ACC as early as possible, ideally within the first ten days of symptom onset, can lead to better outcomes and reduced surgical complexities.

Reference:

Fugazzola, P., Abu-Zidan, F. M., Cobianchi, L., Dal Mas, F., Ceresoli, M., Coccolini, F., Frassini, S., Tomasoni, M., Catena, F., Ansaloni, L., & on behalf of the S.P.Ri.M.A.C.C. Collaborative Group. Timing of Early Cholecystectomy for acute calculous cholecystitis: A multicentric prospective observational study. Healthcare (Basel, Switzerland),2023;11(20):2752. https://doi.org/10.3390/healthcare11202752