Outcome of early cholecystectomy compared to percutaneous drainage of gallbladder and delayed cholecystectomy for patients with acute cholecystitis: systematic review and meta-analysis

Ahmed Nassar* (Corresponding Author), Ibrahim Elshahat, Katharine Forsyth, Shafaque Shaikh, Mudassar Ghazanfar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aim
Compare outcomes of early laparoscopic cholecystectomy (ELC) and percutaneous trans-hepatic drainage of gallbladder (PTGBD) as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC).

Methods
English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay.

Results
Out of 1347 records,14 studies were included. 205,361(94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Mortality was higher in PTGBD; HR,95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs PTGBD group (8.7%) in patients admitted to ICU; P-value=0.011. Patients who had ELC were at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99].

Conclusion
ELC may be a preferred treatment option over PTGBD in AC. However, patient and disease specific factors should be considered to avoid unfavourable outcomes with ELC.

Within the constraints of comparing emergency with elective procedure, ELC is associated with less total hospital stay but more intra-operative blood loss and post-operative complications compared to DLC following PTGBD. Future high-quality studies are needed to assess different management strategies in high-risk surgical patients with complicated AC.
Original languageEnglish
Pages (from-to)1622-1633
Number of pages11
JournalHPB
Volume24
Issue number10
Early online date18 Oct 2022
DOIs
Publication statusPublished - Oct 2022

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