Department of General Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37128, Verona, Italy.
Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
World J Emerg Surg. 2021 Mar 25;16(1):16. doi: 10.1186/s13017-021-00360-5.
Early cholecystectomy for acute cholecystitis has proved to reduce hospital length of stay but with no benefit in morbidity when compared to delayed surgery. However, in the literature, early timing refers to cholecystectomy performed up to 96 h of admission or up to 1 week of the onset of symptoms. Considering the natural history of acute cholecystitis, the analysis based on such a range of early timings may have missed a potential advantage that could be hypothesized with an early timing of cholecystectomy limited to the initial phase of the disease. The review aimed to explore the hypothesis that adopting immediate cholecystectomy performed within 24 h of admission as early timing could reduce post-operative complications when compared to delayed cholecystectomy.
The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complication rate after early and delayed cholecystectomy for acute cholecystitis were included. Studies were grouped based on the timing of cholecystectomy. The hypothesis that immediate cholecystectomy performed within 24 h of admission could reduce post-operative complications was explored by comparing early timing of cholecystectomy performed within and 24 h of admission and early timing of cholecystectomy performed over 24 h of admission both to delayed timing of cholecystectomy within a sub-group analysis. The literature finding allowed the performance of a second analysis in which early timing of cholecystectomy did not refer to admission but to the onset of symptoms.
Immediate cholecystectomy performed within 24 h of admission did not prove to reduce post-operative complications with relative risk (RR) of 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, cholecystectomy performed within 72 h of symptoms was found to significantly reduce post-operative complications compared to delayed cholecystectomy with RR = 0.60 [95% CI 0.39;0.92].
The present study failed to confirm the hypothesis that immediate cholecystectomy performed within 24 h of admission may reduce post- operative complications unless surgery could be performed within 72 h of the onset of symptoms.
早期胆囊切除术治疗急性胆囊炎已被证明可缩短住院时间，但与延迟手术相比，在发病率方面并无获益。然而，在文献中，早期时间点指的是入院后 96 小时内或症状出现后 1 周内进行的胆囊切除术。考虑到急性胆囊炎的自然病程，基于这种早期时间范围的分析可能错过了一个潜在的优势，即可以假设在疾病的初始阶段进行早期的胆囊切除术。本综述旨在探讨以下假说，即在入院后 24 小时内进行即刻胆囊切除术作为早期时间点，与延迟胆囊切除术相比，是否可以降低术后并发症。
文献检索基于患者干预比较结局研究（PICOS）策略进行。纳入了比较急性胆囊炎早期和延迟胆囊切除术后术后并发症发生率的随机试验。根据胆囊切除术的时间将研究分组。通过比较入院后 24 小时内进行的早期胆囊切除术和入院后 24 小时内进行的早期胆囊切除术与延迟胆囊切除术的时间，探索即刻入院后 24 小时内进行胆囊切除术是否可以降低术后并发症的假说。在亚组分析中，将入院后 24 小时内进行的早期胆囊切除术的时间定义为入院后 24 小时内，将入院后 24 小时内进行的早期胆囊切除术的时间定义为入院后 24 小时以上。文献研究结果允许进行第二次分析，即早期胆囊切除术的时间不是指入院，而是指症状发作。
入院后 24 小时内进行即刻胆囊切除术并不能降低术后并发症的相对风险（RR）为 1.89，其 95%置信区间（CI）为[0.76；4.71]。当时间基于症状发作时，与延迟胆囊切除术相比，症状发作后 72 小时内进行的胆囊切除术显著降低了术后并发症的发生风险，RR=0.60[95%CI 0.39；0.92]。
本研究未能证实入院后 24 小时内进行即刻胆囊切除术可能降低术后并发症的假说，除非手术能在症状发作后 72 小时内进行。
