Early versus Delayed Laparoscopic Cholecystectomy for Mild Acute Biliary Pancreatitis: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Laparoscopic cholecystectomy (LC) is widely accepted as the definitive therapeutic approach for MABP, primarily aiming to reduce recurrent biliary complications. However, the optimal timing of LC remains a matter of debate. The aim of this study was to evaluate the efficacy and safety of early laparoscopic cholecystectomy (ELC) versus delayed laparoscopic cholecystectomy (DLC) in patients with mild acute biliary pancreatitis (MABP). Methods The PubMed, Embase, Scopus, and CENTRAL databases were systematically searched for randomized clinical trials (RCTs) comparing ELC with DLC in patients with MABP from inception to August 1, 2023. The primary outcome was recurrent biliary events. Secondary outcomes included postoperative complications, readmissions, and length of stay (LOS). The pooled risk ratio (RR) or standardized mean difference (SMD) of data was calculated using the random-effects model. Results Fifteen RCTs with 1616 patients enrolled between 2010 and 2022 were included. High-certainty evidence from nine RCTs demonstrated a significantly lower risk of recurrent biliary events in patients who underwent ELC during the waiting time compared to DLC (RR=0.128[0.063, 0.262], P<0.001). For secondary outcomes, ELC in patients with MABP was associated with a significantly lower readmission rate (RR=0.382[0.182, 0.801], P=0.011) and shorter LOS (SMD=-2.026[-2.854, -1.198], P<0.001) than DLC. Subgroup analysis indicated that patients with ELC had a significantly lower rate of postoperative complications in accordance with the Atlanta criteria, MABP, and >4 weeks subgroup. Conclusions ELC emerges as a generally safe and effective strategy in reducing recurrent biliary events, postoperative complications, readmission, and length of stay for patients with MABP.