Early or delayed cholecystectomy in acute cholecystitis? A clinical trial

Patients with a preoperative diagnosis of acute cholecystitis were prospectively allocated to treatment with early cholecystectomy (ES) within 7 days of the onset of symptoms, or initial conservative treatment followed by delayed elective surgery (DS). Patients whose symptoms required emergency operation, patients older than 75 years and patients with pancreatitis were excluded from the trial but were followed up. During the study period 402 patients with acute cholecystitis were admitted, 101 fell into the ES group and 91 into the DS group. The conservative regimen had to be interrupted in 15 patients (13·8 per cent) because their clinical status deteriorated and 13 patients (11·9 per cent) in the DS group did not return for planned elective surgery. One patient in the DS group died. There was no difference in the frequency of intra- and postoperative complications between the 2 study groups, the incidence of bacterial complications being markedly low, especially in the ES group. The ES group had a moderate but significantly greater intraoperative blood loss. Hospital stay was almost 1 week shorter in the ES group and insurance payment for loss of working capacity was also shorter in the ES group. These results indicate that early cholecystectomy is the treatment of choice in acute cholecystitis in patients aged 75 years and under.