Source of Evidence:

The Cochrane database of Systematic Reviews 2007 Issue I.

Background

About 10%-15% of adult western population has gallstones and between 1 & 4% become symptomatic in a year. Laparoscopic cholecystectomy which was introduced in 1987 is now the preferred method of cholecystectomy, but there has been considerable controversy regarding the timing of surgery. It has been noted that only 20% of surgeons in the United Kingdom perform laparoscopic cholecystectomies during the acute phase.

Description of Studies:

4886, references and 5 randomised controlled trials studied.

Results:

There were no significant differences in the complication rate, conversion rate or mortality in either group whether the operation was performed during acute cholecystitis or 6 to 12 weeks after the symptoms settle. Additionally 17.5% of patients in the delayed group had non-resolution or recurrence of cholecystitis when they were awaiting their operation.

Conclusions:

It is important for clinicians treating gallstone disease to accept and implement this new approach of treating patients with cholecystitis. Early surgery carried out by experienced surgeons can ensure a good outcome, shortens the hospitals stay and reduces the incidence of readmission of those patients placed on the waiting list.

Edited by:

Mr Neville N Menezes, MS, FRCS, FRCS (Gen.Surg.) Consultant General & Upper GI Surgeon, Ashford and St. Peter’s Hospitals NHS Trust.