Early cholecystectomy for recurrent versus first-time cholecystitis – a nationwide population study

Introduction Acute cholecystitis is the most common complication of gallstone disease. While current guidelines recommend early laparoscopic cholecystectomy, some patients are treated non-surgically. This study aims to compare the complication rates following early cholecystectomy for recurrent versus first-time acute cholecystitis. Method This population-based retrospective cohort study utilized data from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Patients undergoing early cholecystectomy for acute cholecystitis between 2006 and 2020 were included. The primary outcome was the total complication rate within 30 days. Secondary outcomes included rates of open surgery, prolonged surgery, and specific complications. Result Of 34,925 patients, 3,384 underwent surgery for recurrent cholecystitis, and 31,541 for first-time cholecystitis. The recurrent cholecystitis group had significantly higher complication rates (20.2 per cent vs. 13.8 per cent), with an adjusted odds ratio (OR) of 1.38 (CI 1.26-1.52, P< .001). Increased risks for bile duct injury (OR 2.44, CI 1.67-3.56, P< .001) and intestinal perforation (OR 2.54, CI 1.51-4.25, P< .001) were observed. No significant differences were found in intraoperative bleeding, reoperation, or 30-day mortality. Discussion Patients undergoing early cholecystectomy for recurrent cholecystitis have higher risks of complications, bile duct injury, and intestinal perforation compared to those with first-time cholecystitis. These findings support early cholecystectomy for acute cholecystitis during the initial episode, to reduce the risk of morbidity associated with recurrence.