Early Versus Delayed Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review
Abstract
Acute calculous cholecystitis is a common emergency surgical condition, and the optimal timing of laparoscopic cholecystectomy (LC) remains controversial. Previous meta-analyses have not consistently distinguished evidence from randomized controlled trials (RCTs) and observational studies or separated postoperative complications from composite strategy-level morbidity. We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines by searching PubMed, the Cochrane Library, Scopus, and Web of Science from inception through June 2026. Dichotomous outcomes from RCTs were pooled using the DerSimonian-Laird random-effects model, while observational studies were synthesized narratively. Risk of bias was assessed using the revised Cochrane Risk of Bias 2 (RoB 2) tool and the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Seventeen studies met the inclusion criteria (11 RCTs and six observational studies). Meta-analysis of RCTs demonstrated that early LC did not significantly increase conversion to open surgery (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.58-1.38; I² = 0%), bile leak (OR 1.80, 95% CI 0.69-4.66), bile duct injury (OR 0.61, 95% CI 0.15-2.48), mortality (OR 0.94, 95% CI 0.21-4.17), or postoperative complications (OR 0.73, 95% CI 0.38-1.40). In contrast, composite strategy morbidity, which incorporated waiting-period events, was…
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