Meta-analysis of the efficacy and safety of early and delayed laparoscopic surgery in acute cholecystitis

Objective: To evaluate the efficacy and safety of early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in acute cholecystitis (AC). Methods: PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP database, Wanfang database and China Biomedical Literature Database (CBM) online database were searched for RCT test and retrospective analysis of ELC and DLC in patients with AC. During the search period of January 2010 through May 2022, two researchers independently extracted the data, and the bias risk of each contained literature was determined using RevMan5.3 statistical software in accordance with the Cochrane Handbook 5.3. Results: Eventually, there were 7 clinical controlled studies contained, with 4515 samples. The incidence of intraoperative complications did not differ remarkably (P>0.05). Postoperative complications were not remarkably different (P>0.05). The fixed effect model analysis indicated that there exhibited no statistical difference in the rate of conversion to laparotomy (P>0.05). Model analysis indicated that the operative time in the ELC group was less compared the DLC group (P<0.05). The postoperative hospital stay in the ELC group was shorter compared to the DLC group (P<0.05). The hospital stay in the ELC group was less compared to the DLC group (P<0.05). The funnel chart was drawn based on the incidence postoperative complications, conversion to laparotomy, operation time, postoperative hospital stays and total hospital stay. publication bias analysis was carried out. There is a symmetrical pattern in most funnel charts, according to the results. A small part of distribution was asymmetric, suggesting that due to the heterogeneous nature of the study and the small number of included articles, included literature had a certain publication bias. Conclusion: When treating AC, ELC and DLC are not noticeably different in terms surgical complications and conversion to open surgery. The shorter operative time and length of stay in hospital with ELC is worth promoting in the clinical setting. However, for further validation, more studies with higher methodological quality and longer intervention times and follow-ups are needed.