A Randomised Controlled Trial Comparing Early versus Interval Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: A Study of Feasibility and Outcomes.

Abstract

Background: Acute calculous cholecystitis (ACC) is a common surgical emergency. The optimal timing for laparoscopic cholecystectomy (LC) remains controversial.

Aims: This study compared outcomes between early LC (ELC) and interval LC (ILC) for ACC.

Materials and methods: A prospective randomised controlled trial was conducted with 100 patients equally allocated to ELC (within 72 h) or ILC (6-8 weeks post-conservative management). Primary outcomes included operative time, conversion rate and total hospital stay. Secondary outcomes assessed intraoperative events and post-operative complications.

Results: Mean operative time was significantly longer in the ELC group (95.47 min vs. 73.69 min, P = 0.001). Total hospital stay was shorter with ELC (6.50 days vs. 10.80 days, P = 0.009). Conversion rates were higher in the ILC group (18% vs. 8%, P = 0.245). Bile duct injuries occurred exclusively in the ELC group (8% vs. 0%). Significant intraoperative bleeding (80% vs. 56%) and total postoperative complications (30% vs. 8%, P = 0.006) were more frequent with ELC.

Conclusion: ELC reduces hospital stay but is associated with longer operative times and higher complication rates. ILC may offer a safer operative field but extends overall treatment duration. Timing should be individualised based on patient factors, surgical expertise and institutional resources, with stringent adherence to safety principles.