Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND: : In many countries laparoscopic cholecystectomy for acute cholecystitis is mainly performed after the acute episode has settled because of the anticipated increased risk of morbidity and higher conversion rate from laparoscopic to open cholecystectomy. METHODS: : A systematic review was performed with meta-analysis of randomized clinical trials of early laparoscopic cholecystectomy (ELC; performed within 1 week of onset of symptoms) versus delayed laparoscopic cholecystectomy (performed at least 6 weeks after symptoms settled) for acute cholecystitis. Trials were identified from The Cochrane Library trials register, Medline, Embase, Science Citation Index Expanded and reference lists. Risk ratio (RR) or mean difference was calculated with 95 per cent confidence intervals (c.i.) based on intention-to-treat analysis. RESULTS: : Five trials with 451 patients were included. There was no significant difference between the two groups in terms of bile duct injury (RR 0.64 (95 per cent c.i. 0.15 to 2.65)) or conversion to open cholecystectomy (RR 0.88 (95 per cent c.i. 0.62 to 1.25)). The total hospital stay was shorter by 4 days for ELC (mean difference -4.12 (95 per cent c.i. -5.22 to -3.03) days). CONCLUSION: : ELC during acute cholecystitis appears safe and shortens the total hospital stay.

Abdominal lift for laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Several cardiopulmonary changes (decreased cardiac output, pulmonary compliance, and increased peak airway pressure) occur during pneumoperitoneum. These changes may not be tolerated in individuals with poor cardiopulmonary reserve. OBJECTIVES: To assess the benefits and harms of abdominal wall lift compared to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation IndexExpanded until January 2007. SELECTION CRITERIA: We included all randomised clinical trials comparing abdominal wall lift (with or without pneumoperitoneum) and pneumoperitoneum. DATA COLLECTION AND ANALYSIS: We calculated the relative risk (RR), weighted mean difference (WMD) or standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat analysis with both the fixed-effect and the random-effects model using RevMan Analysis. MAIN RESULTS: Abdominal wall lift with pneumoperitoneum versus pneumoperitoneum. A total of 156 participants (all with low anaesthetic risk) who underwent elective laparoscopic cholecystectomy were randomised in six trials to abdominal wall lift with pneumoperitoneum (n = 65) versus pneumoperitoneum only (n = 66). One trial which included 25 patients did not state the number of patients in each group. All six trials were of high risk of bias. The cardiopulmonary changes were less in abdominal wall lift than pneumoperitoneum. There was no difference in the morbidity and pain between the groups. Abdominal wall lift versus pneumoperitoneum. A total of 550 participants (the majority with low anaesthetic risk) who underwent elective laparoscopic cholecystectomy were randomised in fourteen trials to abdominal wall lift without pneumoperitoneum (n = 268) versus pneumoperitoneum (n = 282). Two of these fourteen trials were of low risk of bias. The cardiopulmonary changes were less in abdominal wall lift than with pneumoperitoneum. There was no difference in the morbidity and pain between the groups. The operating time was prolonged in abdominal wall lift compared with pneumoperitoneum (WMD 7.74, 95% CI 1.37 to 14.12). AUTHORS' CONCLUSIONS: (1) Abdominal wall lift seems safe and decreases the cardiopulmonary changes associated with laparoscopic cholecystectomy.(2) Abdominal wall lift does not seem to offer advantage over pneumoperitoneum in any of the patient-oriented outcomes for laparoscopic cholecystectomy in patients with low anaesthetic risk and may increase costs by increasing the operating time. Hence it cannot be recommended routinely. More research on the topic is needed.

Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Drains are used after laparoscopic cholecystectomy to prevent abdominal collections. However, drain use may increase infective complications and delay discharge. OBJECTIVES: The aim is to assess the benefits and harms of routine abdominal drainage in uncomplicated laparoscopic cholecystectomy. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until March 2007. SELECTION CRITERIA: We included all randomised clinical trials comparing drainage with no drainage after uncomplicated laparoscopic cholecystectomy. Randomised clinical trials comparing one type of drain with another were also reviewed. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics, methodological quality, mortality, abdominal collections, pain, nausea, vomiting, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis. MAIN RESULTS: We analysed six trials involving 741 patients randomised to drain (361) versus no drain (380). The only patient with abdominal collections requiring intervention belonged to the drain group. Wound infection was significantly higher in those with a drain (OR 5.86, 95% CI 1.05 to 32.70). Drainage was associated with nausea, but this was not statistically significant. Hospital stay was longer in the drain group and the number of patients discharged at the day of operation was significantly reduced in the no drain group (OR 2.45, 95% CI 0.00 to 0.57, 1 trial). We also reviewed one trial with 41 patients randomised to suction drain (22) versus closed passive drain (19). This trial suggests that suction drains carried less pain than passive drains. AUTHORS' CONCLUSIONS: Drain use after elective laparoscopic cholecystectomy increases wound infection rates and delays hospital discharge. We could not find evidence to support the use of drain after laparoscopic cholecystectomy.

Wound drains following thyroid surgery.

BACKGROUND: The nature and indications for thyroid surgery vary and a perceived risk of haemorrhage post-surgery is one reason why wound drains are frequently inserted. However when a significant bleed occurs, wound drains may become blocked and the drain does not obviate the need for surgery or meticulous haemostasis. The evidence in support of the use of drains post-thyroid surgery is unclear therefore and a systematic review of the best available evidence was undertaken. OBJECTIVES: To determine the effects of inserting a wound drain during thyroid surgery, on wound complications, respiratory complications and mortality. SEARCH STRATEGY: We searched the following databases: Cochrane Wounds Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 1, 2007); MEDLINE (2005 to February 2007); EMBASE (2005 to February 2007); CINAHL (2005 to February 2007) using relevant search strategies. SELECTION CRITERIA: Only randomised controlled trials were eligible for inclusion. Quasi randomised studies were excluded. Studies with participants undergoing any form of thyroid surgery, irrespective of indications, were eligible for inclusion in this review. Studies involving people undergoing parathyroid surgery and lateral neck dissections were excluded. At least 80% follow up (till discharge) was considered essential. DATA COLLECTION AND ANALYSIS: Studies were assessed for eligibility and data were extracted by two authors independently, differences were resolved by discussion. Studies were assessed for validity including criteria on whether they used a robust method of random sequence generation and allocation concealment. Missing and unclear data were resolved by contacting the study authors. MAIN RESULTS: 13 eligible studies were identified (1646 participants). 11 studies compared drainage with no drainage and found no significant difference in re-operation rates; incidence of respiratory distress and wound infections. Post-operative wound collections needing aspiration or drainage were significantly reduced by drains (RR 0.51, 95% CI 0.27 to 0.97), but a further analysis of the 4 high quality studies showed no significant difference (RR 1.82, 95% CI 0.51 to 6.46). Hospital stay was significantly prolonged in the drain group (WMD 1.18 days, 95% CI 0.73 to 1.63).Eleven studies compared suction drain with no drainage and found no significant difference in re-operation rates; incidence of respiratory distress and wound infection rates. The incidence of collections that required aspiration or drainage without formal re-operation was significantly less in the drained group (RR 0.48, 95% CI 0.25 to 0.92). However, further analysis of only high quality studies showed no significant difference (RR 1.78, 95% CI 0.44 to 7.17). Hospital stay was significantly prolonged in the drain group (WMD 1.20 days, 95% CI 0.77 to 1.63). One study compared open drain with no drain. No participant in either group required re-operation. No data were available regarding the incidence of respiratory distress, wound infection and pain. The incidence of collections needing aspiration or drainage without re-operation was not significantly different between the groups and there was no significant difference in length of hospital stay. One study compared suction drainage with passive closed drainage. None of the participants in the study needed re-operation and data regarding other outcomes were not available. Two studies (180 participants) compared open drainage with suction drainage. One study reported wound infections and minor wound collections, both were not significantly different. The other study reported wound collections requiring intervention and hospital stay; both were not significantly different. None of the participants in either study required re-operation. Data regarding other outcomes were not available. AUTHORS' CONCLUSIONS: There is no clear evidence that using drains in patients undergoing thyroid operations significantly improves patient outcomes and drains may be associated with an increased length of hospital stay. The existing evidence is from trials involving patients having goitres without mediastinal extension, normal coagulation indices and the operation not involving any lateral neck dissection for lymphadenectomy.

Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Drains are used after laparoscopic cholecystectomy to prevent abdominal collections. However, drain use may increase infective complications and delay discharge. OBJECTIVES: The aim is to assess the benefits and harms of routine abdominal drainage in uncomplicated laparoscopic cholecystectomy. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until March 2007. SELECTION CRITERIA: We included all randomised clinical trials comparing drainage with no drainage after laparoscopic cholecystectomy. Randomised clinical trials comparing one type of drain with another were also reviewed. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics, methodological quality, mortality, abdominal collections, pain, nausea, vomiting, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis. MAIN RESULTS: We analysed five trials involving 591 patients randomised to drain (281) versus no drain (310). We also reviewed one trial with 41 patients randomised to suction drain (22) versus closed passive drain (19). The only trial that reported on abdominal collections requiring intervention reported no abdominal collections requiring intervention in either group. Wound infection tended to be higher in those with a drain (OR 15.38, 95% CI 0.86 to 275.74). Drainage was associated with lower shoulder, abdominal pain, and nausea, but this was not statistically significant. Hospital stay was longer in the drain group. AUTHORS' CONCLUSIONS: Drain use after elective laparoscopic cholecystectomy reduces early post-operative pain, but increases wound infection rates and delays hospital discharge. We could not find evidence to support the use of drain after laparoscopic cholecystectomy.

Routine abdominal drainage for uncomplicated liver resection.

BACKGROUND: The main reasons for inserting a drain after elective liver resections are (i) prevention of sub-phrenic or sub-hepatic fluid collection; (ii) identification and monitoring of post-operative bleeding; (iii) identification and drainage of any bile leak; and (iv) prevent the accumulation of ascitic fluid in cirrhotics. However, there are reports that drain use increases the complication rates. OBJECTIVES: To assess the benefits and harms of routine abdominal drainage in elective liver resections. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until March 2007. SELECTION CRITERIA: We included all randomised trials comparing abdominal drainage and no drainage in adults undergoing elective liver resection. We also included randomised trials comparing different types of drain in adults undergoing elective liver resection. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using the Cochrane Collaboration statistical software RevMan Analysis. For each outcome we calculated the odds ratio (OR) with 95% confidence intervals (CI) (based on intention-to-treat analysis) by combining the trial data sets using fixed-effect model or random-effects model, as appropriate. MAIN RESULTS: Drain versus no drain: We included five trials with 465 patients randomised: 234 to the drain group and 231 to the no drain group. Three of the five trials were of high methodological quality. There was no statistically significant difference between the two groups for any of the outcomes (mortality, intra-abdominal collections requiring re-operation, infected intra-abdominal collections, wound infection, ascitic leak, and hospital stay, when the random-effects model was adopted. Open drain versus closed drain: One randomised clinical trial of low methodological quality comparing open with closed drainage (186 patients) showed a lower incidence of infected intra-abdominal collections, chest complications, and hospital stay in the closed drain group. AUTHORS' CONCLUSIONS: There is no evidence to support routine drain use after uncomplicated liver resections.

Routine abdominal drainage for uncomplicated open cholecystectomy.

BACKGROUND: Cholecystectomy is the removal of gallbladder and is performed mainly for symptomatic gallstones. Although laparoscopic cholecystectomy is currently preferred over open cholecystectomy for elective cholecystectomy, reports of randomised clinical trials comparing the choice of cholecystectomy (open or laparoscopic) in acute cholecystitis are still being conducted. Drainage in open cholecystectomy is a matter of considerable debate. Surgeons use drains primarily to prevent subhepatic abscess or bile peritonitis from an undrained bile leak. Critics of drain condemn drain use as it increases wound and chest infection. OBJECTIVES: To assess the benefits and harms of routine abdominal drainage in uncomplicated open cholecystectomy. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2006. SELECTION CRITERIA: We included randomised clinical trials comparing 'no drain' versus 'drain' in patients who had undergone uncomplicated open cholecystectomy (irrespective of language, publication status, and the type of drain). Randomised clinical trials comparing one drain with another were also included. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics and methodological quality of each trial, number of abdominal collections requiring different treatments, bile peritonitis, wound infection, chest complications, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome, we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis. MAIN RESULTS: Twenty eight trials involving 3659 patients were included. There were 20 comparisons of 'no drain' versus 'drain' and 12 comparisons of one drain with another. There was no statistically significant difference in mortality, bile peritonitis, total abdominal collections, abdominal collections requiring different treatments, or infected abdominal collections. 'No drain' group had statistically significant lower wound infection (OR 0.61, 95% CI 0.43 to 0.87) and statistically significant lower chest infection (OR 0.59, 95% CI 0.42 to 0.84) than drain group. We found no significant differences between different types of drains. AUTHORS' CONCLUSIONS: Drains increase the harms to the patient without providing any additional benefit for patients undergoing open cholecystectomy and should be avoided in open cholecystectomy.

Cholecystectomy versus no cholecystectomy in patients with silent gallstones.

BACKGROUND: Cholecystectomy is currently advised only for patients with symptomatic gallstones. However, about 4% of patients with asymptomatic gallstones develop symptoms including cholecystitis, obstructive jaundice, pancreatitis, and gallbladder cancer. OBJECTIVES: To assess the benefits and harms of surgical removal of the gallbladder for patients with asymptomatic gallstones. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until 2006 for identifying the randomised trials using The Cochrane Hepato-Biliary Group search strategy. SELECTION CRITERIA: Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing cholecystectomy and no cholecystectomy were considered for the review. DATA COLLECTION AND ANALYSIS: We were unable to identify any randomised clinical trials comparing cholecystectomy versus no cholecystectomy. MAIN RESULTS: We were unable to identify any randomised clinical trial comparing cholecystectomy versus no cholecystectomy. AUTHORS' CONCLUSIONS: There are no randomised trials comparing cholecystectomy versus no cholecystectomy in patients with silent gallstones. Further evaluation of observational studies, which measure outcomes such as obstructive jaundice, gallstone-associated pancreatitis, and/or gall-bladder cancer for sufficient duration of follow-up is necessary before randomised trials are designed in order to evaluate whether cholecystectomy or no cholecystectomy is better for asymptomatic gallstones.

Wound drains after incisional hernia repair.

BACKGROUND: Incisional hernias are caused by the failure of the wall of the abdomen to close after abdominal surgery, leaving a hole through which the viscera protrude. Incisional hernias are repaired by further surgery. Surgical drains are frequently inserted during hernia repair with the aim of facilitating fluid drainage and preventing complications. Traditional teaching has recommended the use of drains after incisional hernia repair other than for laparoscopic ventral hernia repair. More than 50% of open mesh repairs of ventral hernias have drains inserted. However, there is uncertainty as to whether drains are associated with benefits or harms to the patient. OBJECTIVES: To determine the effects on wound infection and other outcomes, of inserting a wound drain during surgery to repair incisional hernias, and, if possible, to determine the comparative effects of different types of wound drain after incisional hernia repair. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (last searched March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library Issue 1, 2006), EMBASE (1974 to March 2006), PubMed (1951 to March 2006), and Science Citation Index Expanded (1974 to March 2006). We also searched the meta-register of controlled trials. SELECTION CRITERIA: We considered all randomised trials performed in adult patients who underwent incisional hernia repair and that compared using a drain with no drain. We also considered trials that compared different types of drain. DATA COLLECTION AND ANALYSIS: We extracted data on the characteristics of the trial, methodological quality of the trials, outcomes (e.g. infection and other wound complications) from each trial. For each outcome we calculated the risk ratio (RR) with 95% confidence intervals (CI) and based on intention-to-treat analysis. MAIN RESULTS: Only one trial was eligible for inclusion in the review with a total of 24 patients randomised to an electrified drain (12 patients) compared with a corrugated drain (12 patients). There were no statistically significant differences between the groups for any of the outcomes (a variety of measures of infection). AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether wound drains after incisional hernia repair are associated with better or worse outcomes than no drains.

Primary closure versus T-tube drainage after open common bile duct exploration.

BACKGROUND: Between 5% and 11% of people undergoing cholecystectomy have common bile duct stones. Open common bile duct exploration is an important operation when endoscopic retrograde cholangio-pancreatography fails or when expertise for laparoscopic common bile duct exploration is not available. The optimal method for performing open common bile duct exploration is unclear. OBJECTIVES: The aim is to assess the benefits and harms of primary closure versus routine T-tube drainage in open common bile duct exploration for common bile duct stones. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until January 2006. SELECTION CRITERIA: We considered for inclusion all randomised clinical trials comparing primary closure (with or without biliary stent) versus T-tube drainage after open common bile duct exploration. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics, methodological quality, mortality, morbidity, operating time, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects model using RevMan Analysis. For each outcome we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis. MAIN RESULTS: We included five trials with 324 patients randomised: 165 to primary closure without stent and 159 to T-tube. Three of the five trials were considered to have adequate methodological quality, but all lacked blinded outcome assessment. The primary closure group had significantly lower positive bile culture (3 trials, OR 0.22, 95% CI 0.10 to 0.45) and wound infection (5 trials, OR 0.29, 95% CI 0.15 to 0.56). When only trials with high methodological quality were included, there was no statistically significant difference in any of the outcomes except positive bile culture, which became non-significant when the random-effects model was used. The deaths of the three patients in the T-tube group were directly related to surgery and sepsis. Bile peritonitis was higher in the T-tube group (2.9%) than in the primary closure group (1%) (not statistically significant). Hospital stay was significantly longer in the T-tube group compared with the primary closure group in three of the four trials, which reported on the hospital stay. The only trial comparing primary closure with stent (37 patients) versus T-tube drainage (44 patients) did not reveal any statistically significant difference in any of the reported outcomes (mortality, re-operations, wound infection, and hospital stay). There was one case of stent migration, which could not be retrieved after two attempts of ERCP. AUTHORS' CONCLUSIONS: Primary closure after common bile duct exploration seems at least as safe as T-tube drainage. We need randomised trials that assess whether stents may offer benefits.

Primary closure versus T-tube drainage after laparoscopic common bile duct stone exploration.

BACKGROUND: Use of T-tube drainage after laparoscopic common bile duct exploration is controversial. We were unable to identify any meta-analysis or systematic reviews of the benefits and harms of T-tube drainage after common bile duct exploration. OBJECTIVES: To assess the benefits and harms of routine primary closure versus T-tube drainage following laparoscopic common bile duct stone exploration. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until January 2006. SELECTION CRITERIA: We considered for inclusion all randomised clinical trials comparing primary closure (with or without a biliary stent) versus T-tube drainage after laparoscopic common bile duct exploration. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics, methodological quality, mortality, morbidity, operating time, and hospital stay from the one identified trial. We analysed the data using the fixed-effect model using RevMan Analysis. For each outcome we calculated the odds ratio (OR) and weighted mean difference (WMD) with 95% confidence intervals based on intention-to-treat analysis. MAIN RESULTS: We included one trial with 55 patients randomised: 27 to the primary closure and 28 to the T-tube group. This trial was of inadequate methodological quality. There was no mortality in either group. There was no statistically significant difference between the two groups for any of the outcomes except for the hospital stay (WMD -2.8 days, 95% CI -1.93 to -3.67), which was lower in the primary closure group. AUTHORS' CONCLUSIONS: We have insufficient evidence to recommend T-tube drainage over primary closure after laparoscopic common bile duct stone exploration or vice versa. Further randomised trials are necessary to assess the benefits and harms of T-tube drainage compared with primary closure after laparoscopic common bile duct exploration.

Early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND: Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% become symptomatic in a year. Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis. OBJECTIVES: The aim was to compare the early laparoscopic cholecystectomy (less than seven days of onset of symptoms) versus delayed laparoscopic cholecystectomy (more than six weeks after index admission) with regards to benefits and harms. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation IndexExpanded until November 2005. SELECTION CRITERIA: We considered for inclusion all randomised clinical trials comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis. MAIN RESULTS: We included five trials with 451 patients randomised: 223 to the early group and 228 to the delayed group. Surgery was performed on 222 patients in the early group and on 216 patients in the delayed group. There was no mortality in any of the trials. Four of the five trials were of high methodological quality. There was no statistically significant difference between the two groups for any of the outcomes including bile duct injury (OR 0.63, 95% CI 0.15 to 2.70) and conversion to open cholecystectomy (OR 0.84, 95% CI 0.53 to 1.34). Various other analyses including 'available case analysis', risk difference, statistical methods to overcome the 'zero-event trials' showed no statistically significant difference between the two groups in any of the outcomes measured. A total of 40 patients (17.5%) from the delayed group had to undergo emergency laparoscopic cholecystectomy due to non-resolving or recurrent cholecystitis; 18 (45%) of these had to undergo conversion to open procedure. The total hospital stay was about three days shorter in the early group compared with the delayed group. AUTHORS' CONCLUSIONS: Early laparoscopic cholecystectomy during acute cholecystitis seems safe and shortens the total hospital stay. The majority of the outcomes occurred rarely; hence, the confidence intervals are wide. Therefore, further randomised trials on the issue are needed.