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.

Keywords: Biliary stones; Cholecystectomy; Cholecystitis; Cholelithiasis; Laparoscopy.

Figure 1

Complicated acute cholecystitis. A: Laparoscopic approach; B: Laparotomic approach.

Figure 2

Transabdominal ultrasound in acute cholecystitis.

Figure 3

Cholescintigraphy in acute calculous cholecystitis.

Figure 4

Laparoscopic cholecystectomy showing the critical view of safety. 1: Common hepatic duct; 2: Cystic duct; 3: Cystic artery.