The liver produces bile which has many functions including assisting in the elimination of waste processed by the liver and digestion of fat. The bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 5% to 25% of the adult western population. Between 2% and 4% become symptomatic in a year. The symptoms include pain related to the gallbladder (uncomplicated biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolourisation of the body usually most prominent in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ which secretes digestive juices and harbours the insulin secreting cells which maintain blood sugar levels (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for people with symptomatic gallstones. This is generally performed by keyhole surgery (laparoscopic cholecystectomy). Gallbladder pain is one of the indications for laparoscopic cholecystectomy and can occur suddenly, with symptoms of intense pain in the right upper tummy which may or may not be associated with other symptoms such as heartburn. This is called biliary colic. Because of the limited resources available in a state-funded health system, the people with biliary colic are added to a waiting list and operated on electively. However, delaying the surgery exposes the people to the risk of complications related to gallstones. The review authors set out to determine whether it is preferable to perform early laparoscopic cholecystectomy (within two weeks of people presenting to doctors with symptoms) or delayed laparoscopic cholecystectomy (more than two weeks after people present to doctors with symptoms). A systematic search of the medical literature was performed in order to identify studies which provided information on the above question. The authors obtained information from randomised trials only since such types of trials provide the best information if conducted well. Two authors independently identified the trials and collected the information.

Only one trial including 75 participants (average age: 43 years; females: 65% of participants) provided information for this review. In this trial, 35 participants underwent early laparoscopic cholecystectomy (less than 24 hours after diagnosis) and 40 participants underwent delayed laparoscopic cholecystectomy after an average waiting period of approximately four months. The treatment that the participants underwent was determined by a method similar to the toss of a coin. This trial was at high risk of bias (systematic errors or errors in study design which may influence the conclusions). There were no deaths in the early group (0 out of 35) (0%) and there was one death (1 out of 40) (2.5%) in the delayed laparoscopic cholecystectomy group. This difference between the groups was not significantly different. There were no serious complications related to the surgery in either group. During the waiting period, 9 out of 40 participants (22.5%) developed gallstone-related serious complications. Five participants in the delayed group revisited the hospital because of recurrent gallbladder pain. In total, 14 participants required hospital admissions for the above symptoms. All of these participants were from the delayed group. All the participants in the early group were operated on within 24 hours. The proportion of participants who developed serious complications was significantly lower in the early group than the proportion of participants in the delayed laparoscopic cholecystectomy group. Quality of life and return to work were not reported in this trial. There was no significant difference in the proportion of participants who required conversion to open removal of the gallbladder. The hospital stay was significantly shorter (by about one day) in the early group than the delayed group. The operating time was significantly shorter (by about 15 minutes) in the early group than the delayed group.

Based on evidence from only one high-bias risk trial, it appears that early laparoscopic cholecystectomy performed within 24 hours of diagnosis of biliary colic decreases serious complications, hospital stay, and operating time compared with delayed laparoscopic cholecystectomy with an average waiting time of four months. Further well designed, randomised clinical trials are necessary to confirm or refute these findings.