Optimal Timing and Outcomes of Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis: A Retrospective Cohort Study

Objective :This study investigates the optimal timing for delayed laparoscopic cholecystectomy (DLC) in patients with acute cholecystitis (AC) who missed the 72-hour window for early surgery. We evaluated how the timing of delayed surgery affects perioperative outcomes, complication Methods :We retrospectively analyzed 76 patients with AC who underwent DLC at Bartın State Hospital between January 2018 and December 2024 after missing the early laparoscopic cholecystectomy (ELC) window. Patients were divided into three groups based on surgical timing: Group 1 (4–14 days from symptom onset), Group 2 (3–6 weeks), and Group 3 (more than 6 weeks). Demographic data, laboratory and imaging findings, surgical details (conversion rate, operative time), and perioperative outcomes were recorded. Statistical analyses were performed to assess the impact of timing on clinical outcomes. Results :Of the 76 patients (56 males, 20 females; mean age: 51 years, range: 22–80), Group 1 included 32 patients, and Groups 2 and 3 included 22 patients each. Conversion to open surgery was more frequent in male patients and those with ultrasound findings of gallbladder wall thickening or severe adhesions. Delayed surgery was associated with elevated CRP, leukocytosis, longer operative times, and prolonged hospital stays. Postoperative complications occurred in 10.5% of cases, with no mortality. Mean operative time was 54 ± 12 minutes. Hospital stays were significantly longer in Groups 2 and 3 ( p  < 0.05). Additionally, 3.9% of Group 3 patients experienced recurrent cholecystitis attacks while awaiting surgery. Conclusion :Although early laparoscopic cholecystectomy (within 72 hours) remains the gold standard for acute cholecystitis, DLC can be performed safely if scheduled within 14 days after symptom onset. Surgical delays beyond 6 weeks are associated with increased complication rates, prolonged hospital stays, and a higher risk of recurrence. Prompt intervention after initial stabilization is critical for optimal outcomes.