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.

中文翻译：

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早期腹腔镜胆囊切除术治疗急性结石性胆囊炎的时机：随机临床试验的荟萃分析

急性胆囊炎的早期胆囊切除术已被证明可以减少住院时间，但与延迟手术相比，在发病率方面没有任何好处。然而，在文献中，早期时间是指在入院 96 小时内或症状出现后 1 周内进行胆囊切除术。考虑到急性胆囊炎的自然病程，基于这样一个早期时间范围的分析可能错过了一个潜在优势，该优势可以假设胆囊切除术的早期时间仅限于疾病的初始阶段。该评价旨在探讨以下假设：与延迟胆囊切除术相比，采用入院 24 小时内进行的即刻胆囊切除术作为早期时间可以减少术后并发症。文献检索是基于患者干预比较结果研究 (PICOS) 策略进行的。纳入了比较早期和延迟胆囊切除术治疗急性胆囊炎术后并发症发生率的随机试验。研究根据胆囊切除术的时间分组。通过比较入院内和入院 24 小时内进行胆囊切除术的早期时间以及入院 24 小时内进行胆囊切除术的早期时间与延迟内胆囊切除术的时间，探讨了在入院 24 小时内进行立即胆囊切除术可以减少术后并发症的假设。亚组分析。文献发现允许进行第二次分析，其中胆囊切除术的早期时间不是指入院而是指症状的出现。入院 24 小时内进行的即刻胆囊切除术并未证明可减少术后并发症，相对风险 (RR) 为 1.89，其 95% 置信区间 (CI) [0.76; 4.71]。当时间基于症状的发作时，发现与延迟胆囊切除术相比，在出现症状 72 小时内进行胆囊切除术可显着减少术后并发症，RR = 0.60 [95% CI 0.39;0.92]。本研究未能证实入院 24 小时内立即进行胆囊切除术可以减少术后并发症的假设，除非可以在症状出现后 72 小时内进行手术。当时间基于症状的发作时，发现与延迟胆囊切除术相比，在出现症状 72 小时内进行胆囊切除术可显着减少术后并发症，RR = 0.60 [95% CI 0.39;0.92]。本研究未能证实入院 24 小时内立即进行胆囊切除术可以减少术后并发症的假设，除非可以在症状出现后 72 小时内进行手术。当时间基于症状的发作时，发现与延迟胆囊切除术相比，在出现症状 72 小时内进行胆囊切除术可显着减少术后并发症，RR = 0.60 [95% CI 0.39;0.92]。本研究未能证实入院 24 小时内立即进行胆囊切除术可以减少术后并发症的假设，除非可以在症状出现后 72 小时内进行手术。