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Research article
Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.
Giuseppe Borzellino
Universita Degli Studi di Verona
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3378-4548
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Background Early cholecystectomy for acute cholecystitis is reported in the literature to be performed up to 96 hours of admission or up to 1 week of the onset of symptoms. Based on the natural history of acute cholecystitis such timing may have missed some potential benefits that could have been expected by performing cholecystectomy in an earlier phase of the disease. The study aimed to explore the hypothesis that an immediate cholecystectomy performed within 24 hours of admission could reduce post-operative complications when compared with delayed cholecystectomy.
Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complications at different timings of cholecystectomy for acute cholecystitis were included. The main outcome was the post-operative complication rate. Studies were grouped based on the timing of cholecystectomy which was defined immediate when performed within 24 hours of admission, early when performed up to 96 hours of admission and delayed when surgery was elective after medical treatment. Pooled data of studies comparing post-operative complications after immediate versus delayed and early versus delayed cholecystectomy were analysed within a sub-group analysis. The literature search finding allowed the performance of a second analysis in which immediate cholecystectomy did not refer to a cholecystectomy performed within 24 hours of admission but within 72 hours of the onset of symptoms.
Results Immediate cholecystectomy performed within 24 hours of admission did not prove to reduce post-operative complications with relative risk (RR) 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, immediate cholecystectomy performed within 72 hours of the onset of symptoms was found to reduce post-operative complications compared to delayed cholecystectomy with RR 0.57 [95% CI: 0.37;0.89].
Conclusion The present study did not confirm the hypothesis that immediate cholecystectomy performed within 24 hours of admission may reduce post- operative complications. However, the finding of studies in which timing referred not to admission but to the onset of symptoms, allows to favour immediate cholecystectomy if performed within 72 hours of the onset of symptoms.
Keywords
acute cholecystitis, laparoscopic cholecystectomy, timing
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CURRENT STATUS: Under Review
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Posted 13 Feb, 2021
Review #1 received
Received 13 Feb, 2021
Editorial decision: Minor revision
On 13 Feb, 2021
Reviewer #2 agreed
On 11 Feb, 2021
Review #2 received
Received 11 Feb, 2021
Editor assigned
On 09 Feb, 2021
Reviewers invited
Invitations sent on 09 Feb, 2021
Reviewer #1 agreed
On 09 Feb, 2021
Submission checks complete
On 09 Feb, 2021
Editor invited
On 09 Feb, 2021
This version was not preprinted
Version 1
Posted 19 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 02 Jan, 2021
Review #3 received
Received 31 Dec, 2020
Review #1 received
Received 16 Dec, 2020
Review #2 received
Received 16 Dec, 2020
Reviewer #3 agreed
On 13 Dec, 2020
Reviewer #2 agreed
On 10 Dec, 2020
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Editor assigned
On 09 Dec, 2020
Editor invited
On 09 Dec, 2020
Submission checks complete
On 18 Nov, 2020
First submitted
On 13 Nov, 2020
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This preprint is under consideration at World Journal of Emergency Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.
Giuseppe Borzellino
Universita Degli Studi di Verona
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3378-4548
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version (no preprint)
Posted 13 Feb, 2021
Review #1 received
Received 13 Feb, 2021
Editorial decision: Minor revision
On 13 Feb, 2021
Reviewer #2 agreed
On 11 Feb, 2021
Review #2 received
Received 11 Feb, 2021
Editor assigned
On 09 Feb, 2021
Reviewers invited
Invitations sent on 09 Feb, 2021
Reviewer #1 agreed
On 09 Feb, 2021
Submission checks complete
On 09 Feb, 2021
Editor invited
On 09 Feb, 2021
This version was not preprinted
Version 1
Posted 19 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 02 Jan, 2021
Review #3 received
Received 31 Dec, 2020
Review #1 received
Received 16 Dec, 2020
Review #2 received
Received 16 Dec, 2020
Reviewer #3 agreed
On 13 Dec, 2020
Reviewer #2 agreed
On 10 Dec, 2020
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Editor assigned
On 09 Dec, 2020
Editor invited
On 09 Dec, 2020
Submission checks complete
On 18 Nov, 2020
First submitted
On 13 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Early cholecystectomy for acute cholecystitis is reported in the literature to be performed up to 96 hours of admission or up to 1 week of the onset of symptoms. Based on the natural history of acute cholecystitis such timing may have missed some potential benefits that could have been expected by performing cholecystectomy in an earlier phase of the disease. The study aimed to explore the hypothesis that an immediate cholecystectomy performed within 24 hours of admission could reduce post-operative complications when compared with delayed cholecystectomy.
Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complications at different timings of cholecystectomy for acute cholecystitis were included. The main outcome was the post-operative complication rate. Studies were grouped based on the timing of cholecystectomy which was defined immediate when performed within 24 hours of admission, early when performed up to 96 hours of admission and delayed when surgery was elective after medical treatment. Pooled data of studies comparing post-operative complications after immediate versus delayed and early versus delayed cholecystectomy were analysed within a sub-group analysis. The literature search finding allowed the performance of a second analysis in which immediate cholecystectomy did not refer to a cholecystectomy performed within 24 hours of admission but within 72 hours of the onset of symptoms.
Results Immediate cholecystectomy performed within 24 hours of admission did not prove to reduce post-operative complications with relative risk (RR) 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, immediate cholecystectomy performed within 72 hours of the onset of symptoms was found to reduce post-operative complications compared to delayed cholecystectomy with RR 0.57 [95% CI: 0.37;0.89].
Conclusion The present study did not confirm the hypothesis that immediate cholecystectomy performed within 24 hours of admission may reduce post- operative complications. However, the finding of studies in which timing referred not to admission but to the onset of symptoms, allows to favour immediate cholecystectomy if performed within 72 hours of the onset of symptoms.
Figure 1
Figure 2
Figure 3
Figure 4