Laparoscopic Cholecystectomy for Acute Cholecystitis: Defining the Golden Period

Background/aims Laparoscopic cholecystectomy (LC) performed within the first week of acute cholecystitis (AC) is generally regarded as safe and effective, while delayed surgery is often recommended for unresolved or complicated cases. This study assessed perioperative outcomes of LC performed during the first week versus two to six weeks following symptom onset. Methods This prospective observational comparative study was conducted at a tertiary care center from January 2021 to December 2024 using data from a prospectively maintained database. Patients with acute calculous cholecystitis who underwent LC within six weeks of symptom onset were included. Patients with acalculous cholecystitis, choledocholithiasis, spreading peritonitis, or cholecystoenteric/choledochoenteric fistula and emergency open cholecystectomy were excluded. Patients were categorized into Group A (surgery within one week) and Group B (surgery between two and six weeks). Operative duration, conversion to open cholecystectomy, postoperative morbidity, and hospital stay were analyzed. Results Among 121 patients, 69 underwent early LC (Group A) and 52 underwent intermediate LC (Group B). Bile leak occurred in 10.1% and 21.2% of cases, respectively (p = 0.057). Mean operative time and subtotal cholecystectomy rates were comparable between groups. The mean duration of hospital stay was approximately 5-6 days (5.68 ± 1.79 days in Group A and 6.21 ± 1.65 days in Group B). Conclusions Intermediate LC represents a safe and practical alternative when early surgery is not feasible, provided appropriate patient selection and meticulous surgical technique are ensured. Early LC should remain the treatment of choice whenever feasible, given its well-established benefits of shorter hospital stay, fewer recurrent biliary events, and lower overall costs.