EP-221 Outcome of early cholecystectomy compared to percutaneous drainage of gallbladder and delayed cholecystectomy for patients with acute cholecystitis: systematic review and meta-analysis

Abstract Aim Compare outcomes of ELC and PTGBD as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC). Methods English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay. Results Out from 1347 records,14 studies were included. 205,361(94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Risk of mortality was considerably higher in PTGBD compared to EC group; HR,95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs 8.7% in PTGBD group in patients admitted to ICU for sepsis related to AC; P-value=0.011. ELC group had more intra-operative blood loss than DLC group; MD (95%CI): 34.2 (4.15, 64.25) ml. There was no difference in mortality between the two groups; HR (95% CI): 1.30 [0.60, 2.83] Patients had ELC are at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile leak or bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99]. Conclusion ELC should be considered for all patients with acceptable surgical risk admitted with AC regardless its severity. PTGBD can be considered for patients admitted to the ICU for organ support. Future studies needed to assess the validity of this approach.