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Years ago, cholecystectomy often was delayed for weeks in patients with acute cholecystitis; the rationale was that delayed surgery — after antibiotic therapy had reduced inflammation — would be easier and safer than early surgery. More recently, research has suggested that early surgery is in fact preferable. Two new studies shed additional light on this issue.
In a multicenter trial from Germany, 618 patients with acute cholecystitis were randomized to immediate laparoscopic cholecystectomy (≤24 hours after hospital admission) or to antibiotic therapy and delayed surgery (7–45 days after presentation). Critically ill patients and those with perforation or abscess were excluded. During 75 days of follow-up, the immediate-surgery group had s…