Re-Evaluating the Role of Delayed Cholecystectomy: Safety and Timing in the Management of Acute Cholecystitis

Nan-Ak Wiboonkhwan

doi:10.64387/tjs.2026.278785

Authors

Nan-ak Wiboonkhwan Department of Surgery, Songklanagarind Vejchavivat Hospital

DOI:

https://doi.org/10.64387/tjs.2026.278785

Keywords:

Acute cholecystitis, Cholecystectomy, Delayed cholecystectomy, Early cholecystectomy, Laparoscopic cholecystectomy, Safe cholecystectomy

Abstract

Background: Early laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis (AC) to reduce hospital stay and costs, but optimal timing remains debated due to severe complications like bile duct injury (BDI). Delayed LC (DLC) after conservative management or drainage provides a safer alternative with lower postoperative complications and BDI rates

Materials and Methods: This narrative review analyzed literature from PubMed and Embase (1990–October 2025). Surgical timing was categorized by inflammation phases: Early (<7 days), Intermediate (7 days to 6 weeks), and Delayed (>6 weeks). Evidence from RCTs, meta-analyses, and registries was evaluated, with a focus on BDI risks, surgeon experience, and hospital readiness. Limitations include potential selection bias and lack of formal quality assessment.

Results: Under optimal conditions, early LC reduced hospital stay and costs but was associated with higher postoperative complication rates (up to 26.7%). BDI rates peaked at 2.8% when operating between days 4–7, and open conversion rates reached 21%–28.6% in Grade I/II cases. Conversely, delayed LC after drainage mitigated these risks; one study reported zero conversions in the delayed group, and a meta-analysis showed a significantly higher BDI risk (HR 6.07) with early intervention.

Conclusion: Choosing between early and delayed LC must be individualized, prioritizing patient safety over economic benefits. While early LC is preferred under optimal conditions, it requires high expertise. In resource-variable settings, delayed LC serves as an essential, safer alternative that aligns with international guidelines.

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