Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis.
BACKGROUND
Previous studies comparing early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were incomplete. A meta-analysis was undertaken to compare the cost-effectiveness, quality of life, safety and effectiveness of ELC versus DLC.


METHODS
PubMed, Embase, the Cochrane Library and Web of Science were searched for randomized clinical trials (RCTs) that compared ELC (performed within 7 days of symptom onset) with DLC (undertaken at least 1 week after symptoms had subsided) for acute cholecystitis.


RESULTS
Sixteen studies reporting on 15 RCTs comprising 1625 patients were included. Compared with DLC, ELC was associated with lower hospital costs, fewer work days lost (mean difference (MD) -11·07 (95 per cent c.i. -16·21 to -5·94) days; P < 0·001), higher patient satisfaction and quality of life, lower risk of wound infection (relative risk 0·65, 95 per cent c.i. 0·47 to 0·91; P = 0·01) and shorter hospital stay (MD -3·38 (-4·23 to -2·52) days; P < 0·001), but a longer duration of operation (MD 11·12 (4·57 to 17·67) min; P < 0·001). There were no significant differences between the two groups in mortality, bile duct injury, bile leakage, conversion to open cholecystectomy or overall complications.


CONCLUSIONS
For patients with acute cholecystitis, ELC appears as safe and effective as DLC. ELC might be associated with lower hospital costs, fewer work days lost, and greater patient satisfaction.
First College of Clinical Medicine, Chongqing Medical University, Chongqing, China.
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Wu
Graduate College of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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Tian
Department of Clinical Medicine, Shandong University, Jinan, China.
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Liu
Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota, USA.
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Wu
Graduate College of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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Zhao
Department of Graduate School, Guangxi Medical University, Nanning, China.
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Zhao
D001208:Asia; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D041881:Cholecystitis, Acute / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004534:Egypt; D005060:Europe; D006801:Humans; D015233:Models, Statistical; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome