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Acute Cholecystitis: Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial (ACDC Study, NCT00447304)

Gutt, Carsten N. MD*; Encke, Jens MD; Köninger, Jörg MD*; Harnoss, Julian-Camill MD*; Weigand, Kilian MD; Kipfmüller, Karl MD§; Schunter, Oliver MD; Götze, Thorsten MD; Golling, Markus T. MD**; Menges, Markus MD††; Klar, Ernst MD‡‡; Feilhauer, Katharina MD; Zoller, Wolfram G. MD§§; Ridwelski, Karsten MD¶¶; Ackmann, Sven MD‖‖; Baron, Alexandra MD***; Schön, Michael R. MD†††; Seitz, Helmut K. MD‡‡‡; Daniel, Dietmar MSc§§§; Stremmel, Wolfgang MD; Büchler, Markus W. MD*,¶¶¶

doi: 10.1097/SLA.0b013e3182a1599b
Papers of the 133rd ASA Annual Meeting

Objective: Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.

Background: Optimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics.

Methods: The ACDC (“Acute Cholecystitis—early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy”) study is a randomized, prospective, open-label, parallel group trial. Patients were randomly assigned to receive immediate surgery within 24 hours of hospital admission (group ILC) or initial antibiotic treatment, followed by delayed laparoscopic cholecystectomy at days 7 to 45 (group DLC). For infection, all patients were treated with moxifloxacin for at least 48 hours. Primary endpoint was occurrence of predefined relevant morbidity within 75 days. Secondary endpoints were as follows: (1) 75-day morbidity using a scoring system; (2) conversion rate; (3) change of antibiotic therapy; (4) mortality; (5) costs; and (6) length of hospital stay.

Results: Morbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314 patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0 days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly lower in group ILC.

Conclusions: In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304)

Supplemental Digital Content is Available in the Text.This large, randomized trial including 618 patients compares early surgery shortly after hospital admission and delayed elective surgery after conservative treatment with moxifloxacin. Laparoscopic cholecystectomy within 24 hours was superior concerning morbidity and costs. Therefore, we believe that immediate surgery should become therapy of choice for acute cholecystitis in operable patients.

Departments of *Surgery and

Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany

Department of Surgery, Katharinen Hospital, Stuttgart, Germany;

§Department of Surgery, St. Marien Hospital Muelheim, Muelheim

Department of Surgery, Bietigheim Hospital, Bietigheim-Bissingen, Germany

Department of Surgery, Ketteler Hospital, Offenbach, Germany;

Departments of **Surgery I and

††Internal Medicine II, Diakonie Hospital, Schwaebisch Hall, Germany

‡‡Department of Surgery, Rostock University Hospital, Germany

§§Department of Internal Medicine, Katharinen Hospital, Stuttgart, Germany;

Departments of ¶¶Surgery and

‖‖Gastroenterology, Magdeburg Hospital, Magdeburg, Germany

***Department of Surgery, Bad Cannstatt Hospital, Stuttgart, Germany

†††Karlsruhe Hospital, Karlsruhe, Germany;

Department of ‡‡‡Internal Medicine, Salem Hospital, Heidelberg, Germany

§§§Research and Public Relations, Burscheid, Germany

¶¶¶Department of Surgery, Salem Hospital, Heidelberg, Germany.

Reprints: Markus W. Büchler, MD, Department of Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. E-mail:

Supported by a grant including study medication from Bayer Vital GmbH, Leverkusen, Germany.

Disclosure: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Büchler reports receipt of a grant for this study from Bayer Vital GmbH, Leverkusen, Germany. Drs Encke and Gutt have received honoraria for lecturing, and Drs Büchler, Encke, and Gutt have been reimbursed for travel expenses from Bayer Vital GmbH. The remaining authors declare no conflicts of interest.

The sponsor had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data and in the preparation, review, or approval of the manuscript.

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© 2013 by Lippincott Williams & Wilkins.