A 60-year-old woman with gallstones presents with acute cholecystitis. She is stabilised medically. What is the OPTIMAL timing of laparoscopic cholecystectomy according to current evidence?
- A Early laparoscopic cholecystectomy within 72 hours of symptom onset ✓
- B Delayed interval cholecystectomy — 6 weeks after symptom resolution
- C Open cholecystectomy is preferred in acute cholecystitis
- D Percutaneous cholecystostomy as definitive treatment in all cases
Correct answer: A. Early laparoscopic cholecystectomy within 72 hours of symptom onset
Explanation
Multiple RCTs and meta-analyses (including the Tokyo Guidelines 2018) confirm that early laparoscopic cholecystectomy within 72 hours of symptom onset in acute cholecystitis is safe and superior to delayed interval cholecystectomy. Early surgery reduces total hospital stay, readmission risk, conversion rates due to fibrosis, and the risk of recurrent cholecystitis during the waiting period. Delayed surgery was previously preferred to reduce inflammation but evidence now clearly favours early intervention in fit patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.