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Meta-Analysis
. 2024 Nov 28;409(1):366.
doi: 10.1007/s00423-024-03555-x.

Evaluating the 7-day barrier: early laparoscopic cholecystectomy for cholecystitis with prolonged symptom duration; a systematic review and meta-analysis

Max H G van Maasakkers  1 , Teus J Weijs  2 , Oscar P Cnossen  2 , Willemieke G van Braak  2 , Johannes C Kelder  3 , Didier Roulin  4 , Djamila Boerma  2
Affiliations
Meta-Analysis

Evaluating the 7-day barrier: early laparoscopic cholecystectomy for cholecystitis with prolonged symptom duration; a systematic review and meta-analysis

Max H G van Maasakkers et al. Langenbecks Arch Surg. .

Abstract

Background: The gold standard for treating acute cholecystitis is an early laparoscopic cholecystectomy. However, whether this still applies for a > 7-day existing cholecystitis remains heavily debated. Therefore, this systematic review investigates the safety of early laparoscopic cholecystectomy for a > 7-day existing cholecystitis.

Methods: PubMed and Embase were systematically searched for all studies comparing early laparoscopic cholecystectomy in patients with 0-7 versus > 7-day existing cholecystitis at time of surgery. Meta-analyses were performed on dichotomous and continuous outcomes with risk difference (RD) and mean difference (MD) as measures of effect.

Results: A total of 3007 studies were screened, resulting in the inclusion of 13 non-randomised studies comprising 5481 patients. Of these, 4690 received cholecystectomy within 7 days, and 791 after 7 days. Operating times (MD -11.8 min; 95% CI [-18.4; -5.2]) and total hospital stay (MD -2.7 days; 95% CI [-4.0; -1.4]) were longer in the > 7-day group. However, no significant risk difference was found for combined major complications: bile duct injury/leakage and bowel injury (RD -1.0%; 95% CI [-2.3; 0.3]), for complications graded Clavien-Dindo ≥ 3 (RD -0.3%; 95% CI [-2.5; 1.9]), or for conversions (RD -1.5%; 95% CI [-3.9; 0.9]).

Conclusion: Early laparoscopic cholecystectomy for cholecystitis after the 7-day barrier might be harder, as reflected by longer operating times. However, a significant increase in complications or conversions was not found. Due to the risk of bias and lack of well-powered studies directly comparing early cholecystectomy after 7 days with alternative strategies, strong recommendations cannot be made. Meanwhile, it is advised to carefully weigh the treatment options in case of a > 7-day existing cholecystitis, based on patient's characteristics and surgeon's experience.

Keywords: Cholecystitis; Early laparoscopic cholecystectomy; Laparoscopic cholecystectomy; Timing.

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Conflict of interest statement

Ethics. Ethics approval and consent to participate: Not applicable. The manuscript is not under consideration for publication elsewhere. Competing interests: The authors declare no competing interests. Disclosures: M.H.G. van Maasakkers, T.J. Weijs, O.P. Cnossen, W.G. van Braak, J.C. Kelder, D Roulin, and D. Boerma have no conflicts of interest to disclose.

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