Early vs delayed laparoscopic cholecystectomy in acute cholecystitis

Aim: to compare outcome of early vs delayed laparoscopic cholecystectomy in acute cholecystitis. design: it was a randomized controlled trial. place and duration of study: this study was conducted at the department of surgery unit-i,ghurki trust teaching hospital,lahore over 1 year period from march 2014 through june 2015. methods: this study involved 210 patients presenting at emergency department of ghurki trust teaching hospital,lahore with acute cholecystitis. patients with previous abdominal surgery,surgical jaundice,ultrasound-proven choledocholithiasis,acute gallstone-induced pancreatitis and those with significant comorbid conditions falling under asa class ≥iii were excluded from this study. these patients were randomly allocated into 2 treatment groups using lottery method. group-a (30 cases) underwent early (48-72 hours of diagnosis) while group-b (30 cases) underwent delayed laparoscopic cholecystectomy. outcome measures included mean operative time,mean operative blood loss,mean vas score for post-operative pain at 24 hours and frequency of bile duct injury. results: the age of the patients ranged from 37 years to 63 years with a mean of 51.13±8.05 years. there were 40(19%) male and 170 (81%) female patients in the study sample giving a male:female ratio of 1:4.26. there was no statistically significant difference between the two groups in terms of mean age (p=0.139) and gender (p=0.725). the mean operating time (112.25±10.16 vs. 154.94±7.83 minutes; p=0.000) and mean operative blood loss (26.50±4.44 vs. 75.72±6.82ml; p=0.000) were significantly lower in group-i as compared to group-ii. however,the frequency of bile duct injury was significantly higher in group-i (10.5% vs. 0%; p=0.001). while there was statistically insignificant difference between the two groups in terms of post-operative pain (2.98±0.96 vs. 2.43±0.85; p=0.668). conclusion: early laparoscopic cholecystectomy was found to be associated with significantly shorter mean operating time and decreased mean operative blood loss but with significantly higher frequency of bile duct injury as compared to delayed laparoscopic cholecystectomy with acute cholecystitis.