Comparison of Outcomes of Early and Delayed Laparoscopic Cholecystectomies in UK Clinical Practice: A Systematic Review.

introductionEmergency surgical services in the UK face rising pressures, and early laparoscopic cholecystectomy (ELC) is inconsistently implemented despite National Institute for Health and Care Excellence (NICE) and the World Society of Emergency Surgery (WSES) recommendations. Limited emergency theatre capacity and scheduling bottlenecks contribute to variability. This study aimed to evaluate clinical outcomes and system impact of ELC versus delayed laparoscopic cholecystectomy (DLC) in the UK.

methodsA systematic review of UK-based studies (2000-2025) was conducted using PubMed, Europe PubMed Central (PMC), ScienceDirect, and Cochrane Library. Eleven retrospective cohort studies were included, comprising a total of 97,574 patients who underwent laparoscopic cholecystectomy (LC). The included studies examined ELC (within 72 hours of admission) with DLC or conservative management. Outcomes assessed included conversion to open surgery, complications, length of stay (LOS), and 30-day readmissions. Cost savings were estimated using NHS reference data (£465 per inpatient bed-day).

resultsELC was associated with reduced LOS (three to five vs. six to nine days) and lower 30-day readmission rates (1.6% vs. up to 31%). Conversion to open surgery was consistently lower in most ELC studies (0% to 5%), although one study reported rates as high as 24.2% in patients delayed beyond 72 hours of symptom onset. Across the 11 included UK-based studies (n=97,574), all patients were acute admissions deemed fit for surgery. Reporting of comorbidity, disease severity, and intraoperative difficulty measures was inconsistent: only two studies performed adjusted analyses for preoperative factors, comorbidity was reported in a minority, and no study used standardised severity grading. Complication rates were comparable or lower, with serious events such as bile duct injuries and bile leaks being rare. One large national study reported bile duct injury rates of 0.8% in the early group compared to 1.8% in delayed surgery. Some studies noted slightly higher intraoperative drain use or minor bile leaks in early cases, but without increased LOS. Estimated cost savings ranged from £1,000 to £2,000 per patient, equating to £14-28 million annually.

conclusionELC is a safe, effective, and cost-saving approach for acute calculous cholecystitis (ACC) in the NHS. It reduces hospital stays and readmissions, with minimal increase in conversion risk. Broader adoption via dedicated emergency theatre slots and "hot gallbladder" lists may improve patient outcomes and ease NHS surgical pressures.