162 Does Timing Influence Outcomes in Acute Cholecystitis? A Systematic Review of Early Versus Delayed Laparoscopic Cholecystectomy.

Abstract Introduction Laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis. Every year, 1.5 million cholecystectomies are performed in the US and over 60,000 in the UK. However, the optimal timing of the surgery remains a topic of debate. Aim To evaluate the safety and efficacy of early laparoscopic cholecystectomy (ELC) versus delayed laparoscopic cholecystectomy (DLC) in adult with acute cholecystitis, using only high-quality evidence from randomised controlled trials (RCTs). Method A systematic search of PubMed, Embase, and Cochrane Central from inception through June 2025 was performed. RCTs comparing ELC (during index admission) and DLC (> 4weeks after conservative management) in adults with acute cholecystitis were included. Primary outcomes were conversion to open surgery and postoperative complications; secondary outcomes included intraoperative complications, wound infections, bile leaks, common bile duct (CBD) injuries, operative time, and hospital stay. Results Twenty-one RCTs with 1731 patients (ELC 869, DLC 862) were analysed. There was no statistically significant difference between the two groups in conversion rates, postoperative complications, wound infections, bile leaks, CBD injuries, and operative times. However, ELC was associated with increased overall intraoperative complications (RR 1.82, 95% CI: 1.17 to 2.82; P=0.008) and significantly shorter hospital stays (MD –3.50 days, 95% CI: -4.11 to -2.90; P<0.00001). Conclusions ELC reduces hospital stays without increasing overall postoperative complications or conversion rates but carries a higher risk of intraoperative complications. Factors such as disease severity and surgeon experience may influence these outcomes, warranting further research to identify patients most suitable for early surgery.