General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa.
Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, Bologna.
Surg Laparosc Endosc Percutan Tech. 2022 Dec 1;32(6):755-763. doi: 10.1097/SLE.0000000000001103.
Acute cholecystitis (AC) is largely diffused among population worldwide. Laparoscopic cholecystectomy is the treatment of choice. Current evidence suggests a clinical benefit of early cholecystectomy. The aim of the present study was to evaluate the different "timing" ("early" vs. "delayed" cholecystectomy), through the application of network meta-analyses, to define the most adequate interval associated with the best outcomes.
A network meta-analysis of randomized controlled trials was conducted.
Early cholecystectomy ≤72 hours from symptoms reduced conversion rate in comparison to: cholecystectomy ≤7 days from symptoms ( P =0.044), delayed cholecystectomy within 1 to 5 weeks from first admission ( P =0.010) and 6 to 12 weeks from symptoms resolutions ( P =0.009). Delaying cholecystectomy to 6 to 12 weeks reduces operating time in respect to early cholecystectomy ≤72 hours from symptoms ( P =0.001), within 24 hours from admission ( P =0.001), ≤72 hours from admission ( P =0.001) and ≤7 days from symptoms ( P =0.001). Cholecystectomy ≤24 hours from admission was the best strategy to reduce total in-hospital stay, whereas delaying cholecystectomy to 6 to 12 weeks was the worst strategy. The same applied when cholecystectomy was performed ≤72 hours from symptoms in respect to both delayed strategies ( P =0.001 for both comparisons) or when it was performed ≤72 hours from admission ( P =0.001 for both comparisons). Cholecystectomy ≤72 hours from symptoms onset was the best strategy to reduce postoperative complications, the worst was represented by delayed cholecystectomy at 1 to 5 weeks from first admission.
AC should be operated as soon as possible. AC surgical management should be considered in a dynamic time conception to optimize clinical, organizational, and economical outcomes.
急性胆囊炎（AC）在全球范围内广泛存在。腹腔镜胆囊切除术是首选治疗方法。目前的证据表明早期胆囊切除术具有临床获益。本研究旨在通过网络荟萃分析评估不同的“时机”（“早期”与“延迟”胆囊切除术），以确定与最佳结果相关的最佳间隔时间。
进行了一项随机对照试验的网络荟萃分析。
与以下情况相比，症状出现后 72 小时内进行早期胆囊切除术可降低转化率：症状出现后 7 天内进行胆囊切除术（P=0.044）、首次就诊后 1 至 5 周内进行延迟胆囊切除术（P=0.010）和症状缓解后 6 至 12 周内进行胆囊切除术（P=0.009）。与症状出现后 72 小时内进行早期胆囊切除术相比，延迟至 6 至 12 周进行胆囊切除术可降低手术时间（P=0.001）、首次就诊后 24 小时内（P=0.001）、72 小时内（P=0.001）和 7 天内（P=0.001）。首次就诊后 24 小时内进行胆囊切除术是减少总住院时间的最佳策略，而延迟至 6 至 12 周进行胆囊切除术是最差的策略。当胆囊切除术在症状出现后 72 小时内进行时，对于这两种延迟策略，这一结论均适用（两者比较均 P=0.001），或者当胆囊切除术在就诊后 72 小时内进行时，这一结论也同样适用（两者比较均 P=0.001）。症状出现后 72 小时内进行胆囊切除术是减少术后并发症的最佳策略，而最差的策略是首次就诊后 1 至 5 周进行延迟胆囊切除术。
AC 应尽快手术。AC 的手术管理应考虑在动态时间概念中，以优化临床、组织和经济结果。
