62 Early or Delayed? Comparing Outcomes of Laparoscopic Cholecystectomy in UK Practice: A Systematic Review

Abstract Background UK emergency surgery services are under increasing pressure, and early laparoscopic cholecystectomy (ELC) is not uniformly adopted despite support from NICE and WSES guidelines for acute calculous cholecystitis. Barriers include limited theatre access and the lack of dedicated emergency lists. This review evaluates the clinical and system-level impact of ELC versus delayed laparoscopic cholecystectomy (DLC) in the UK. Method A systematic search of PubMed, Europe PMC, ScienceDirect, and Cochrane Library (2000–2025) identified 11 UK-based retrospective cohort studies (>95,000 patients) comparing ELC (within 72 hours of admission or 7–10 days from symptom onset) with DLC or conservative management. Outcomes included conversion to open surgery, complications (bile leak, drain use), length of stay (LOS), and 30-day readmission. NHS bed-day cost (£465/day) was used for economic analysis. Results ELC was associated with shorter LOS (3–5 vs 6–9 days) and lower 30-day readmissions (∼2% vs up to 30%). Complication rates were similar or lower. Minor bile leaks and drain use were slightly more common with ELC but did not affect LOS. Conversion to open surgery was occasionally higher in ELC groups (∼20% vs <10%), likely due to greater inflammation. DLC led to more recurrent biliary events and system burden. LOS reductions with ELC yielded cost savings of £1–2k per patient—£15–30 million annually (15,000 cases/year). Conclusions ELC is safe, effective, and cost-saving. Wider adoption through “hot gallbladder” lists and prioritised theatre access would benefit patients and the NHS.