Prolonged versus delayed laparoscopic cholecystectomy for acute cholecystitis: Time to change the concept – A multicenter randomized controlled trial

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis (AC) and is recommended within 72 hours (early LC, ELC) or six weeks (delayed LC, DLC) of symptom onset. Unfortunately, most patients presented after the 72 hours and refused initial conservative treatment until DLC. Evidence regarding LC beyond 72 hours (prolonged LC, PLC) is still insufficient. Objectives: This study aimed to compare the outcomes of PLC and DLC in patients with AC 72 hours. Patients and Methods: This trial included all patients treated with LC for AC after 72 hours of symptom onset. The patients were randomly divided into two groups according to the time of LC. After admission, PLC was performed as soon as possible, and DLC was postponed for at least six weeks after the initial conservative treatment. Results: 354 patients were randomized into two groups. The overall morbidity was significantly lower in the PLC group. The mean length of the total hospital stays and duration of total antibiotic therapy was significantly shorter in the PLC group. The median total cost was significantly lower in the PLC group. In addition, PLC significantly promoted the early return to work. However, the mean operative time was significantly shorter in the DLC group. The groups had no significant differences in the conversion rate or complications. Conclusions: PLC for AC after 72 hours of symptom onset is safe and associated with lower overall morbidity, shorter total hospital stay, shorter total antibiotic duration, reduced total cost, and fewer lost workdays than DLC