Early laparoscopic cholecystectomy beneficial for biliary colic

Clinical question: 
What are the benefits and harms of early versus delayed laparoscopic cholecystectomy for patients with biliary colic due to gallstones?
Bottom line: 
Based on evidence from only 1 trial with a high risk of bias, it appears that early laparoscopic cholecystectomy (<24 hours after diagnosis of biliary colic) decreases the morbidity during the waiting period for elective laparoscopic cholecystectomy, decreases the rate of conversion to open cholecystectomy (0% v 20%), decreases operating time (by about 15 minutes), and decreases hospital stay (by 1 day). Fourteen patients (35%) required 18 hospital admissions for symptoms related to gallstones during the mean waiting period of 4.2 months in the delayed group – equivalent to 11 admissions per 100 persons per month.
Caveat: 
These results are based on 1 trial which involved only 75 patients, and had a high risk of systematic errors due to unclear allocation concealment and lack of blinding and sample size calculation.
Context: 
Cholecystectomy for symptomatic gallstones is one of the commonest abdominal operations performed. Laparoscopic cholecystectomy is usually performed on a delayed (elective) basis for gallstone pain (without gallbladder inflammation), ie, biliary colic, but can be performed as an emergency surgery. Patients can develop life-threatening complications while waiting for surgery.
Review CD#: 
CD007196
PEARLS No: 
132
Date: 
January, 2009
Authored by: 
Brian R McAvoy