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Prolonged Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

S

South Valley University

Status

Completed

Conditions

Acute Cholecystitis

Treatments

Procedure: Laparoscopic cholecystectomy

Study type

Interventional

Funder types

Other

Identifiers

NCT05736003
SVU/MED/SUR011/4/23/4/611

Details and patient eligibility

About

Gallbladder stone affects 10-15% of the adult population, and about 15-25% of these patients presented with acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is considered the treatment of choice for patients with AC, and recent studies suggest that early laparoscopic cholecystectomy (ELC) is preferable. However, the optimal time for ELC in AC is still controversial.

Early laparoscopic cholecystectomy (ELC) was advised for patients presented within 72 hours, while conservative treatment and planned delayed laparoscopic cholecystectomy (DLC) after six weeks was recommended for patients presented after 72 hours. Surgeons almost always encounter patients with AC lasting more than 72 hours and these patients consistently refuse conservative treatment and postpone for the DLC.

Full description

Gallbladder stone affects 10-15% of the adult population, and about 15-25% of these patients presented with acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is considered the treatment of choice for patients with AC, and recent studies suggest that early laparoscopic cholecystectomy (ELC) is preferable. However, the optimal time for ELC in AC is still controversial.

Early laparoscopic cholecystectomy (ELC) was advised for patients presented within 72 hours, while conservative treatment and planned delayed laparoscopic cholecystectomy (DLC) after six weeks was recommended for patients presented after 72 hours. ELC might be associated with a significant reduction in morbidity and mortality rates, comparable conversion rates, shorter hospital stays, lower costs, and higher patient satisfaction.

Surgeons almost always encounter patients with AC lasting more than 72 hours and these patients consistently refuse conservative treatment and postpone the DLC. Additionally, 15% of patients do not respond to the conservative treatment and still need an emergency cholecystectomy and another 25% of patients require re-hospitalization for recurrent attacks of AC and biliary colic, biliary pancreatitis, cholangitis, and calcular obstructive jaundice during the interval waiting for the DLC. Furthermore, DLC has a higher cost and is time-consuming.

Prolonged LC (PLC) for AC after 3 days from onset of symptoms was thought to be more technically difficult and dangerous because of altered anatomo-pathology where suppurative and subsequently necrotizing cholecystitis develops after edematous cholecystitis during the first 2 to 4 days of symptoms, and this may be associated with increased perioperative complications and conversion rate. On the contrary, others believed that hyperemia and edema may help the dissection. All the studies in the literature focus on the ELC and DLC with little data regarding the safety and feasibility of LC for acute cholecystitis beyond 72 hours of symptoms.

More clinical trials are needed for the optimal management of acute cholecystitis after 72 hours of symptoms. The aim of this study was to compare the clinical outcomes of prolonged and delayed LC in patients with acute cholecystitis more than 72 hours of symptoms.

Enrollment

437 patients

Sex

All

Ages

20 to 70 years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

  1. Patients diagnosed with acute cholecystitis beyond 72 hours of symptoms onset,
  2. American Society of Anesthesiologists (ASA) scores I - III,
  3. Aged 20-70 years,
  4. Agreement to complete the study

Exclusion criteria

  1. Gallbladder polyp,
  2. common bile duct stones,
  3. acute biliary pancreatitis,
  4. cholangitis,
  5. perforated cholecystitis,
  6. biliary peritonitis,
  7. pregnancy

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Double Blind

437 participants in 2 patient groups

Prolonged laparoscpic cholecystectomy
Experimental group
Description:
Patients received laparoscopic cholecystectomy for acute cholecystitis after 27 hours of symptoms
Treatment:
Procedure: Laparoscopic cholecystectomy
Delayed laparoscpic cholecystectomy
Active Comparator group
Description:
Patients received laparoscopic cholecystectomy for acute cholecystitis after 6 weeks of symptoms
Treatment:
Procedure: Laparoscopic cholecystectomy

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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