Meta-analysis of randomized controlled trials and population based studies in acute cholecystitis are in favor for early laparoscopic surgery versus a delayed operation several weeks later. The main problems in these studies are the exclusion criteria used, thus not reflecting the real world setting of acute cholecystitis. The purpose of this study is to demonstrate that a delayed laparoscopic cholecystectomy in a real world scenario has no worse outcome in comparison with an early operation (within 72 hours after onset of symptoms).
Full Title of Study: “When Results of Randomised Controlled Trials and Population Based Studies do Not Reflect the Real World: A Cohort Study in Acute Cholecystitis”
- Study Type: Observational
- Study Design
- Time Perspective: Retrospective
- Study Primary Completion Date: September 2015
Randomized controlled trials (RCTs) and population based studies are in favor of an early operation in acute cholecystitis (1, 2). Thus, one of the largest RCT so far, demonstrated significant more complications in a group of delayed cholecystectomy. The main problems in these studies are the exclusion criteria used, ie severe cases are not considered.
In a cohort study all cholecystectomy patients are analysed to demonstrate that delayed laparoscopic cholecystectomy (DLC) in a real world setting has a less complication rate than early cholecystectomy (ELC).
Academic Teaching Hospital with 400 beds, seven departments (anesthesiology and intensive care medicine, orthopaedics and trauma surgery, visceral and thoracic surgery, gastroenterology, cardiology, gynecology and obstetrics, psychiatry. The visceral and thoracic department has a main focus on minimally invasive techniques.
All cholecystectomy patients during 1/2006 and 9/2015
Clavien Dindo Complication score, American Society of Anaesthesiologist (ASA) Score, conversion rate, onset of symptoms, histology, hospital stay
- Procedure: Laparoscopic cholecystectomy (LC)
- Removal of the gallbladder via a minimally invasive approach
Arms, Groups and Cohorts
- Early laparoscopic cholecystectomy (ELC)
- Operation within 72 hours after onset of symptoms
- Intermediate cholecystectomy (ILC)
- Operation within 14 days after onset of symptoms
- Delayed LC (DLC)
- Operation after 6-12 weeks
- Elective laparoscopic cholecystectomy
- Biliary colic with no acute cholecystitis
Clinical Trial Outcome Measures
- Clavien-Dindo-Complication Score
- Time Frame: 3-6 days
- During the hospital stay after Operation, which is usually between 3 and 6 days, all complications according to the Clavien-Dindo-Complication Score, are recorded.
- Conversion rate
- Time Frame: Intraoperatively
- How often is the laparoscopic approach changed to the open procedure.
Participating in This Clinical Trial
- All patients with cholecystectomies
- No exclusion criteria
Gender Eligibility: All
Minimum Age: N/A
Maximum Age: N/A
Are Healthy Volunteers Accepted: No
- Lead Sponsor
- Asklepios Klinik Langen
- University Hospital, Frankfurt
- Provider of Information About this Clinical Study
- Principal Investigator: Prof. Dr. Dr. Ernst Hanisch, Prof. Dr. Dr. – Asklepios Klinik Langen
- Overall Official(s)
- Ernst W Hanisch, Prof Dr Dr, Principal Investigator, Asklepios Klinik Langen
Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, Schunter O, Götze T, Golling MT, Menges M, Klar E, Feilhauer K, Zoller WG, Ridwelski K, Ackmann S, Baron A, Schön MR, Seitz HK, Daniel D, Stremmel W, Büchler MW. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013 Sep;258(3):385-93. doi: 10.1097/SLA.0b013e3182a1599b.
de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, Nathens AB. Comparative operative outcomes of early and delayed cholecystectomy for acute cholecystitis: a population-based propensity score analysis. Ann Surg. 2014 Jan;259(1):10-5. doi: 10.1097/SLA.0b013e3182a5cf36.
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