Early Laparoscopic Cholecystectomy Achieves Best Outcomes

The first-line therapy for acute cholecystitis, which affects more than 200,000 people in the United States annually, is typically laparoscopic cholecystectomy performed within 3 days of diagnosis, according to a review article published in JAMA.

“Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs,” wrote Jared R. Gallaher, MD, MPH; Anthony Charles, MD, MPH, of the University of North Carolina School of Medicine in Chapel Hill.

After an exam and ultrasound or hepatobiliary scintigraphy confirm an acute cholecystitis — or gallbladder inflammation — diagnosis, laparoscopic cholecystectomy within 3 days is best for most patient populations, the article advised. Even in pregnancy, early laparoscopic cholecystectomy is recommended for all trimesters and is associated with a 1.6% risk of maternal-fetal complications, compared with a 18.4% risk with delayed operative management. In adults older than 65, laparoscopic cholecystectomy is linked with 15.2% mortality at 2-year follow-up compared with 29.3% mortality with nonoperative management.

For patients with exceptionally high perioperative risk, percutaneous cholecystostomy tube placement can be effective, although it was associated a postprocedural complication rate of 65%, compared with a 12% rate for laparoscopic cholecystectomy, in a randomized trial.

“For patients with acalculous acute cholecystitis, percutaneous cholecystostomy tube should be reserved for patients who are severely ill at the time of diagnosis; all others should undergo a laparoscopic cholecystectomy,” the authors advised.

—Jolynn Tumolo

Reference:

Gallaher JR, Charles A. Acute cholecystitis: a review. JAMA. 2022;327(10):965-975.