Comparison of Postoperative Outcomes between Early and Delayed Laparoscopic Cholecystectomy in Adults with Acute Calculous Cholecystitis: A Randomized Controlled Study

Abstract

Background: Acute calculous cholecystitis (ACC) is a common surgical emergency, yet the optimal timing of laparoscopic cholecystectomy remains debated. This randomized controlled trial compared postoperative outcomes between early laparoscopic cholecystectomy (ELC) performed within 72–96 hours of symptom onset and delayed laparoscopic cholecystectomy (DLC) performed after 6–8 weeks of conservative management.

Methods: This prospective, parallel-group, superiority randomized controlled trial with a 1:1 allocation ratio was conducted at a Tertiary Care Hospital of Rawalpindi over a period of time from January 2024 to December 2025. A total of 314 adult patients (aged 18–65 years) with ACC per Tokyo Guidelines 2018 criteria and fit for surgery (ASA I–III) were randomized to ELC (n=157) or DLC (n=157). The primary outcome was conversion to open surgery. Secondary outcomes included total hospital stay, operative time, intraoperative blood loss, postoperative complications (Clavien-Dindo classification), readmission rates, 30-day mortality, and time to return to normal activity. Analysis followed the intention-to-treat principle.

Results: Baseline characteristics were comparable between groups. Conversion to open surgery was significantly lower in the ELC group (7.0% vs. 18.5%; RR 0.38, 95% CI 0.20–0.73; p=0.004; NNT 9). ELC was associated with shorter operative time (71 vs. 87 minutes; p<0.001), reduced blood loss (54.1 vs. 69.7 mL; p<0.001), shorter hospital stay (3.2 vs. 6.5 days; p<0.001), faster return to normal activity (13.9 vs. 20.7 days; p<0.001), lower surgical site infection rates (2.5% vs. 8.3%; p=0.046), and elimination of pre-surgical readmissions (0.0% vs. 12.1%; p<0.001). Overall complications (10.2% vs. 12.7%; p=0.595), bile duct injury (0.6% vs. 1.3%; p=1.000), and 30-day mortality (0.0% vs. 1.9%; p=0.248) did not differ significantly.

Conclusions: Early laparoscopic cholecystectomy within 72–96 hours of symptom onset is superior to delayed surgery, with lower conversion rates, shorter hospital stay, faster recovery, and fewer readmissions, while maintaining a comparable safety profile. These findings support early laparoscopic cholecystectomy as the preferred management strategy for acute calculous cholecystitis in patients fit for surgery.