Acute calculous cholecystitis: Review of current best practices

Abstract

Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.

Right hypochondrial pain leading to diagnosis of cholestatic jaundice and cholecystitis: a review and case study

“…Localised peritonism is more indictive of acute cholecystitis, one of the considered differentials. As a result of this inflammatory process individuals are likely to present with fever, pain lasting several hours or days, previous episode of biliary pain and tenderness on palpation known as Murphy's' positive (Gomes et al, 2017). Murphy's sign is a clinical examination tool where when the subcostal region of the right hypochondrium is palpated on inspiration the gallbladder to descent towards the examiners hand, evoking pain and a sudden cessation of inspiration (Douglas, Nicol and Robertson 2013).…”

Patient Compliance in Laparoscopic Cholecystectomy versus Open Cholecystectomy

“…Operative cholangiogram or common bile duct exploration is reliant on factors allied with common bile duct stones, for example, elevated bilirubin and dilated common bile duct (over 8 mm). The abdomen is then closed in a standard multilayer fashion [17,18] . There are times where the gallbladder is tense and distended from inflammation that might require to be drained with a decompression needle before starting the procedure.…”

Meta‐analysis of the cost‐effectiveness of early versus delayed cholecystectomy for acute cholecystitis

“…Acute calculous cholecystitis (ACC) is a common and significant disease around the world and may often have a high socioeconomic impact 1 . Laparoscopic cholecystectomy is the best treatment for ACC in the majority of patients 2,3 , and contemporary evidence, including randomized studies, population studies and meta-analyses, has clearly demonstrated the clinical benefit of early cholecystectomy in which surgery is undertaken during the index admission 4 -11 . These benefits include reduced morbidity, shorter duration of hospital stay and higher patient satisfaction.…”