title: Delayed laparoscopic cholecystectomy increases the total hospital stay compared to an early laparoscopic cholecystectomy after acute cholecystitis: an updated meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The objective of this study was to review the available prospective, randomized, controlled trials to determine whether an early (ELC) or a delayed (DLC) approach to a laparoscopic cholecystectomy is associated with an increase in length of hospitalization after acute cholecystitis.
  
  
  METHODS
  Medline, the Cochrane Trials Register and EMBASE were searched for prospective, randomized, controlled trials (RCTs) comparing ELC versus DLC, published up to May 2014. A meta-analysis was performed using Review Manager 5.0.
  
  
  RESULTS
  Nine RCTs were included in a total of 617 who underwent ELC and 603 patients who underwent DLC after acute cholecystitis. The mean hospital stay was 5.4 days in the ELC group and 9.1 days in the DLC group. The meta-analysis showed a mean hospital stay significantly lower in the ELC group [medical doctor (MD) = 3.24, 95% confidence interval (CI) = 1.95-4.54, P < 0.001]. The major biliary duct injury rate in the ELC group was 0.8% (2/247) and 0.9% (2/223) in the DLC group. The meta-analysis showed no significant difference between the ELC and DLC groups [relative risk (RR) =0.96, 95%CI = 0.25-3.73, P = 0.950].
  
  
  CONCLUSIONS
  DLC is associated with a longer total hospital stay but equivalent morbidity as compared to ELC for patients presenting with acute cholecystitis. ELC would appear to be the treatment of choice for patients presenting with ELC.
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Menahem
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mulliri
authors.affiliation: Department of Radiology, University Hospital of Caen, Caen Cedex, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Fohlen
authors.affiliation: Cancers and Prevention Laboratory, Research Department, University Hospital of Caen INSERM U 1086, Centre François Baclesse, Caen Cedex, France.
authors.forename: Lydia
authors.initials: L
authors.lastname: Guittet
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Alves
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Lubrano
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors