Early Versus Interval Laparoscopic Cholecystectomy in Acute Cholecystitis: A Prospective Comparative Cross-Sectional Study
Abstract
Background: Acute cholecystitis is commonly managed by laparoscopic cholecystectomy, but the timing of surgery remains clinically relevant because acute inflammation can increase technical difficulty while delayed surgery requires a second treatment episode. Objectives: To compare early and interval laparoscopic cholecystectomy in acute cholecystitis with respect to operative feasibility, intraoperative difficulty, conversion to open surgery, postoperative complications, and hospital stay. Methods: This prospective comparative cross-sectional study included 50 adults treated in the Department of General Surgery, Andhra Medical College and King George Hospital, Visakhapatnam, from September 2022 to January 2024. The study prospectively compared two predefined clinical groups at the time of operative management: 25 patients undergoing early laparoscopic cholecystectomy within 7 days of symptom onset and 25 undergoing interval laparoscopic cholecystectomy at least 6 weeks after resolution of the acute episode. All procedures began laparoscopically. Results: Mean age was 45.72 ± 13.88 years in the early group and 49.28 ± 11.47 years in the interval group. Conversion to open cholecystectomy occurred in 28.0% and 16.0%, respectively. Intraoperative difficulty occurred in 60.0% versus 36.0%. Transient bile leak (16.0% vs. 12.0%), superficial wound infection (20.0% vs. 8.0%), and atelectasis (24.0% vs. 16.0%) showed no statistically significant between-group differences. Mean hospital stay was 9.80 ± 6.87 versus 9.88 ± 6.75 days. Age correlated positively with hospital stay (r = 0.36). Conclusion: Early laparoscopic cholecystectomy was feasible in selected patients with uncomplicated acute cholecystitis. Although technical difficulty and conversion were numerically higher, short-term complication rates and hospital stay were not significantly different from interval surgery. Recommendations: Early laparoscopic cholecystectomy can be considered for eligible patients when appropriate surgical expertise, perioperative support, and safe bailout strategies are available. Larger multicenter studies should confirm comparative effectiveness and uncommon adverse outcomes.