Materiały źródłowe

• #1 Treatment of acute calculous cholecystitis – UpToDate

  https://www.uptodate.com/contents/treatment-of-acute-calculous-cholecystitis/print

  Treatment of acute calculous cholecystitis […] Cholecystectomy is the mainstay of treatment for ACC. Poor surgical candidates may benefit from initial nonoperative management with antibiotics and a gallbladder drainage procedure; those whose surgical risk improves after resolution of the acute inflammation should undergo elective gallbladder surgery to prevent recurrent symptoms. […] The treatment of ACC will be reviewed here.

• #2 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084823/

  Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 710 days from symptom onset. […] In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). […] The treatment of AC is based on the disease severity, the presence of complications, and pre-existing conditions and comorbidities. ELC represents the cornerstone in the treatment of AC, but, in some circumstances, when ELC is contraindicated, delayed surgery is performed. Medical treatment, in particular antibiotic therapy, is also of pivotal importance. Sometimes, GBD placement may be indicated.

• #3 Acute cholecystitis

  https://www.nhs.uk/conditions/acute-cholecystitis/

  Acute cholecystitis is potentially serious because of the risk of complications. […] It usually needs to be treated in hospital with rest, intravenous fluids and antibiotics. […] If you’re diagnosed with acute cholecystitis, you’ll probably need to be admitted to hospital for treatment. […] Initial treatment will usually involve: not eating or drinking (fasting) to take the strain off your gallbladder, receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration, taking medicine to relieve your pain. […] You’ll also be given antibiotics if it’s thought you have an infection. […] Removing your gallbladder may be recommended at some point after initial treatment to prevent acute cholecystitis coming back and reduce your risk of developing potentially serious complications. […] This type of surgery is known as a cholecystectomy. […] A laparoscopic cholecystectomy is often recommended within 1 week of confirming acute cholecystitis. […] If surgery is not an option, you may be offered a procedure to drain away the fluid that has collected in your gallbladder.

• #4 Cholecystitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-20364895

  Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts on X-ray images. A thin, flexible tube with a camera on the end, called an endoscope, goes through the throat and into the small intestine. The dye enters the ducts through a small hollow tube, called a catheter, passed through the endoscope. Tiny tools passed through the catheter also can be used to remove gallstones. […] Treatment for cholecystitis most often involves a hospital stay to control the swelling and irritation, called inflammation, in your gallbladder. Sometimes, surgery is needed. […] At the hospital, treatments to control your symptoms may include: Fasting. You may not be able to eat or drink at first to take stress off your inflamed gallbladder. […] Antibiotics to fight infection. You might need these if your gallbladder is infected.

• #5 Acute Cholecystitis Treatment & Management: Approach Considerations, Initial Therapy and Antibiotic Treatment, Conservative Treatment of Uncomplicated Cholecystitis

  https://emedicine.medscape.com/article/171886-treatment

  Treatment of acute cholecystitis depends on the severity of the condition and the presence or absence of complications. Uncomplicated cases can often be treated on an outpatient basis; complicated cases may necessitate a surgical approach. In patients who are unstable, percutaneous transhepatic cholecystostomy drainage may be appropriate. Antibiotics may be given to manage infection. Definitive therapy involves cholecystectomy or placement of a drainage device; therefore, consultation with a surgeon is warranted. Consultation with a gastroenterologist for consideration of endoscopic retrograde cholangiopancreatography (ERCP) may also be appropriate if concern exists about the presence of choledocholithiasis. […] In acute cholecystitis, the initial treatment includes bowel rest, intravenous hydration, correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. For mild cases of acute cholecystitis, antibiotic therapy with a single broad-spectrum antibiotic is adequate.

• #6 Acute cholecystitis | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/acute-cholecystitis/

  If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment. […] Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder, receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration, taking medication to relieve your pain. […] If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home. […] In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy.

• #7 Acute Cholecystitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/acute-cholecystitis

  Treatment usually involves antibiotics and cholecystectomy. […] Management includes hospital admission, IV fluids, and analgesics, such as a nonsteroidal anti-inflammatory drug (NSAID; ketorolac) or opioid. Nothing is given orally, and nasogastric suction is instituted if vomiting or an ileus is present. Parenteral antibiotics are usually initiated to treat possible infection, but evidence of benefit is lacking. Empiric coverage, directed at gram-negative enteric organisms, involves IV regimens such as ceftriaxone plus metronidazole, piperacillin/tazobactam, or ticarcillin/clavulanate. […] Cholecystectomy cures acute cholecystitis and relieves biliary pain. Early cholecystectomy is generally preferred, best done during the first 24 to 48 hours in the following situations: The diagnosis is clear and patients are at low surgical risk. Patients are older or have diabetes and are thus at higher risk of infectious complications. Patients have empyema, gangrene, perforation, or acalculous cholecystitis.

• #8 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084823/

  In the course of AC, clinicians should keep the patient on fasting and initiate antimicrobial therapy. General supportive care, such as fluid and electrolyte intravenous infusion, and possibly analgesic agent administration, are also mandatory. […] The cornerstone of AC treatment is ELC. In particular, ELC performed within 72 h should be the method of choice for the treatment of AC, because it is related to a shorter hospital stay, fewer perioperative complications, and reduced costs. […] In patients with mild AC but with a concomitant high surgical risk, ELC can be performed once the medical treatment has improved the patients general condition. […] In contrast, in patients with moderate AC, ELC must be preceded by medical therapy because of the possible surgical challenges related to the inflammatory reaction. […] GBD, also known as cholecystostomy, should be performed in all patients with severe AC in whom cholecystectomy is contraindicated. Moreover, GBD should also be considered in patients with moderate AC and a high surgical risk, particularly in case of an inadequate response to the medical treatment.

• #9 Acute Cholecystitis Medication: Antiemetics, Analgesics, Antibiotics

  https://emedicine.medscape.com/article/171886-medication

  The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Agents used in patients with cholecystitis include antiemetics, analgesics, and antibiotics. […] Treatment of cholecystitis with antibiotics should provide coverage against the most common organisms, including Escherichia coli and Bacteroides fragilis, as well as Klebsiella, Pseudomonas, and Enterococcus species. Sanford Guide recommendations for the treatment of cholecystitis include ampicillin/sulbactam or piperacillin/tazobactam for nonlife-threatening cases of cholecystitis. In life-threatening cases, Sanford recommends imipenem/cilastatin or meropenem. Alternatives include metronidazole plus a third-generation cephalosporin, ciprofloxacin, or aztreonam. […] Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients.

• #10 Updates on Antibiotic Regimens in Acute Cholecystitis

  https://www.mdpi.com/1648-9144/60/7/1040

  The definitive treatment of AC is represented by cholecystectomy or, in the case of high-risk patients, by percutaneous cholecystostomy performed by interventional radiologists or gallbladder drainage through endoscopic procedures. For AAC, the treatment of choice is cholecystectomy, even if percutaneous cholecystostomy represents a valid alternative in patients with organ failure or hemodynamic instability. […] Early empirical antimicrobial therapy along with source control of infection is the cornerstone for a successful treatment which, if inadequate, represents an independent predictor factor of mortality. The Surgical Infection Society Guidelines recommend a maximum of four days of antibiotic therapy in patients with severe AC undergoing surgery; on the other hand, they recommend against the use of post-operative antibiotics in patients with mild or moderate AC.

• #11 Antibiotic selection based on microbiology and resistance profiles of bile from gallbladder of patients with acute cholecystitis | Scientific Reports

  https://www.nature.com/articles/s41598-021-82603-8

  Broad-spectrum -lactam and -lactamase inhibitors, such as ampicillin-sulbactam, have been recommended as the first-line drugs to treat enterococcal infections. […] For gram-negative microorganisms, piperacillin-tazobactam and third- or fourth-generation cephalosporins are recommended as the first drugs of choice, and fluoroquinolones and carbapenems are recommended as the second choice, depending on the severity of the illness and antimicrobial susceptibility patterns. […] The role of antimicrobial therapy varies depending on the severity of the illness and etiologic characteristics. In grade I acute cholecystitis, as it is not obvious whether bacteria play a significant role, antimicrobial therapy is administered to prevent progression to infection before cholecystectomy. For grade II acute cholecystitis, antimicrobial therapy is therapeutic and required until the gallbladder is removed. […] Therefore, these antibiotics are not appropriate for initial empiric antimicrobial therapy, and piperacillin-tazobactam or cefepime, which have broader spectra and lower resistance rates, would be more appropriate, especially for patients with severe infections.

• #12 Acute cholecystitis medical therapy – wikidoc

  https://www.wikidoc.org/index.php/Acute_cholecystitis_medical_therapy

  The mainstay of treatment for acute cholecystitis (calculous and acalculous) is surgery. Pharmacologic medical therapy is recommended for cases of acute cholecystitis in which surgery is delayed. Empiric pharmacologic medical therapies for acute cholecystitis include either amoxicillin-clavulanic acid, cefoxitin, cefotaxime, or ceftriaxone with metronidazole, and ciprofloxacin or levofloxacin with metronidazole. The duration of medical therapy after the cholecystectomy depends on the severity of the disease. […] Pharmacologic medical therapy is recommended for cases of acute cholecystitis (calculous and acalculous) in which surgery is delayed and in complicated cases. […] Empiric pharmacologic medical therapies for acute cholecystitis include either amoxicillin-clavulanic acid, cefoxitin, cefotaxime, or ceftriaxone with metronidazole, and ciprofloxacin or levofloxacin with metronidazole.

• #13 Acute cholecystitis medical therapy – wikidoc

  https://www.wikidoc.org/index.php/Acute_cholecystitis_medical_therapy

  Antibiotics are not indicated for the conservative management of acute calculous cholecystitis or in patients scheduled for cholecystectomy. […] The duration of the antibiotic in acute cholecystitis depends on the severity of the disease. Antibiotic therapy should be discontinued within 24 hours of cholecystectomy for mild cholecystitis unless there is evidence of infection extending outside of the gallbladder. Antibiotic therapy is discontinued within 4-7 days for moderate-severe cholecystitis. In the cases of bacteremia with gram-positive bacteria known to cause infective endocarditis (eg, Enterococcus and Streptococcus), consider continuing antibiotics for 14 days.

• #14 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00336-x

  Acute calculus cholecystitis (ACC) has a high incidence in the general population. […] The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. […] ELC has a central role in the management of patients with ACC. […] The development of local policies for safe laparoscopic cholecystectomy is recommended. […] Cholecystectomy is the most common therapeutic approach for ACC and is considered the standard of care for gallstone disease for the majority of patients.

• #15 Cholecystitis treatment: Types, when to see a doctor, and more

  https://www.medicalnewstoday.com/articles/cholecystitis-treatment

  There are two different types of cholecystectomy: Laparoscopic cholecystectomy: Most surgeons perform this type of gallbladder removal. […] Open cholecystectomy: This involves making a larger surgical cut. […] An ERCP is a nonsurgical procedure for cholecystitis. Doctors may use ERCP to remove a gallstone that blocks the common bile duct. […] A doctor may recommend taking bile salt tablets, such as ursodiol and chenodiol, to break down some small gallstones over time. […] Treating cholecystitis usually involves surgery to remove the gallbladder. An individual will undergo initial treatment in the hospital, which may involve supervised fasting, pain relievers, and IV therapy. […] Nonsurgical treatments, such as endoscopic retrograde cholangiopancreatography (ERCP) and oral dissolution therapy are available for people who cannot tolerate a cholecystectomy.

• #16 Acute Cholecystitis Treatment & Management: Approach Considerations, Initial Therapy and Antibiotic Treatment, Conservative Treatment of Uncomplicated Cholecystitis

  https://emedicine.medscape.com/article/171886-treatment

  Laparoscopic cholecystectomy is the standard of care for the surgical treatment of acute cholecystitis. Studies have indicated that early laparoscopic cholecystectomy resulted in shorter total hospital stays with no significant difference in the conversion rates or complications. […] The American College of Radiology (ACR) criteria state that laparoscopic cholecystectomy is the primary mode of treatment for acute cholecystitis. […] For patients at high surgical risk, placement of a sonographically guided, percutaneous, transhepatic cholecystostomy drainage tube coupled with the administration of antibiotics may provide definitive therapy. […] Endoscopic retrograde cholangiopancreatography (ERCP) allows visualization of the anatomy and can provide therapy by removing stones from the common bile duct. […] Studies indicate that this procedure may be safe as an initial, interim, or definitive treatment of patients with severe acute cholecystitis who are at high operative risk for immediate cholecystectomy.

• #17 Acute cholecystitis ➤ causes, symptoms and treatment

  https://www.operarme.com/blog/acute-cholecystitis-causes-symptoms-and-treatment/

  When it comes to gallbladder removal, the specialist can resort to 2 main treatment options. […] Open cholecystectomy: this is the conventional surgery used to remove the gallbladder. […] Laparoscopic cholecystectomy: this type of minimally invasive procedure is defined as a surgical procedure that allows access to the interior of the abdominal cavity by introducing 2 or 3 surgical instruments in the form of a rod, one of them equipped with an optical lens, through 2 or 3 small incisions in the abdominal wall in order to dissect and remove the gallbladder without the need to open the abdominal wall in a larger incision.

• #18 Surgical and Nonsurgical Management of Gallstones | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0515/p795.html

  Cholecystectomy, usually laparoscopic, is recommended for most patients with symptomatic gallstones. […] Prophylactic treatment, usually with laparoscopic cholecystectomy, should be recommended for patients with biliary-type symptoms or those with complications of gallstones, because these patients are likely to have recurrent and more severe symptoms. […] Treatment of acute biliary colic primarily involves pain control with nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotic pain relievers. […] Patients with symptomatic gallstones can be divided into two categories: those who have simple biliary colic and those with complications. […] In a Cochrane review of laparoscopic cholecystectomy vs. open cholecystectomy, laparoscopic surgery was similar to the open procedure in complication rates and surgical time, but resulted in a shorter hospital stay (three fewer days; 95% confidence interval, 2.3 to 3.9 days) and shorter convalescence period (22 fewer days; 95% confidence interval, 8 to 37 days).

• #19 Acute cholecystitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-cholecystitis/

  Acute cholecystitis refers to the acute inflammation of the gallbladder, which is typically due to cystic duct obstruction by a gallstone (acute calculous cholecystitis). […] Empiric antibiotic therapy and laparoscopic cholecystectomy are the mainstays of treatment. Laparoscopic cholecystectomy should be performed as soon as possible, preferably within 72 hours of admission, unless operative and anesthesia risks outweigh the benefits of urgent surgery. […] In high-risk patients with severe cholecystitis, a temporizing gallbladder drainage procedure (e.g., percutaneous cholecystostomy, endoscopic gallbladder stenting) should be performed and elective interval cholecystectomy scheduled after the resolution of acute symptoms. […] Empiric antibiotic therapy and cholecystectomy are the mainstays of treatment for acute cholecystitis after initial supportive therapy.

• #20 Cholecystitis | Temple Health

  https://www.templehealth.org/services/conditions/cholecystitis

  Cholecystitis treatment usually requires a cholecystectomy surgical gallbladder removal. Therapies include: […] Laparoscopic cholecystectomy This is the most common treatment. It is a minimally invasive procedure involving smaller incisions and a faster recovery. Surgeons remove your gallbladder using a laparoscope a long, thin instrument with a tiny video camera and surgical tools. Usually, you can leave the hospital on the same day or the next morning. […] Open cholecystectomy If you have certain more complex conditions, you may require traditional open surgery under general anesthetic. This requires a larger cut in your abdomen and a longer recovery time. You may require 2 to 3 days of hospitalization and a month or more until full recovery. […] Cholecystostomy tube A drain is placed directly into the gallbladder via a small hole in the skin to drain the bile. This is usually done if you have had symptoms of cholecystitis for a longer period of time or if surgery is thought to be too risky. […] Medications This is treatment done with antibiotics and only offered when symptoms are mild.

• #21 A Review of Cholelithiasis and Cholecystitis for Pharmacists

  https://www.uspharmacist.com/article/a-review-of-cholelithiasis-and-cholecystitis-for-pharmacists

  The standard surgical treatment for chronic cholecystitis is elective laparoscopic cholecystectomy, which is associated with low morbidity and can be done as an outpatient surgery. Open cholecystectomy necessitates hospital admission and lengthier recovery time. Open cholecystectomy is often suggested in patients who are not laparoscopic candidates, such as those with extensive prior surgeries and adhesions. In certain patients whose medical condition makes cholecystectomy too difficult, a more minimal procedure, cholecystostomy, which involves inserting a tube into the gallbladder, may be performed. […] Antibiotics used to treat acute cholecystitis empirically target gram-negative enteric organisms and involve IV regimens (e.g., ceftriaxone 2 g every 24 hours plus metronidazole 500 mg every 8 hours; piperacillin/tazobactam 4 g every 6 hours; or ticarcillin/clavulanate 4 g every 6 hours). Patients should be screened for drug allergies and contraindications prior to administration.

• #22 Cholecystitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-20364895

  Procedure to remove stones. You may have a procedure called an endoscopic retrograde cholangiopancreatography (ERCP). This procedure uses dye to make the bile ducts show up during imaging. Then a healthcare professional can use instruments to remove stones blocking the bile ducts or cystic duct. […] Gallbladder drainage. Sometimes, gallbladder drainage, called cholecystostomy, can remove infection. You might have this procedure if you can’t have surgery to remove your gallbladder. […] The procedure to remove the gallbladder is called a cholecystectomy. Most often, this is a minimally invasive procedure called laparoscopic cholecystectomy. […] The timing of surgery depends on how bad your symptoms are and your overall risk of complications during and after surgery. If your surgical risk is low, you might have surgery during your hospital stay. […] In time, most people with cholecystitis need surgery to remove the gallbladder.

• #23 Acute cholecystitis | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/acute-cholecystitis/

  Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder. […] If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks. […] Surgery can be carried out in two main ways: laparoscopic cholecystectomy a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen, open cholecystectomy where the gallbladder is removed through a single, larger incision in your abdomen. […] In about 1 in every 5 cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.

• #24 Acute cholecystitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-cholecystitis/

  The initial procedure and duration of antibiotic therapy depend on severity grading of acute cholecystitis, patient’s individual surgical risk, and presence of complications. […] Laparoscopic cholecystectomy should be performed as soon as possible, unless operative and anesthesia risks outweigh the benefits of urgent surgery. […] Gallbladder drainage procedures (e.g., percutaneous cholecystostomy) typically performed as a temporizing measure for unstable or clinically deteriorating patients: e.g., grade IIIII acute cholecystitis. […] Perform preoperative or postoperative stone extraction in patients with concurrent choledocholithiasis. […] Early laparoscopic cholecystectomy is the preferred treatment for all trimesters. […] Conservative management of acute cholecystitis in pregnancy is associated with a higher risk of recurrence and complications than laparoscopic cholecystectomy.

• #25 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00336-x

  The literature review, the discussion of the relevant evidence and the statements made during the consensus conference (CC) held in Jerusalem in 2015 (Third WSES International Congress) supported surgery as the gold standard treatment for all patients with ACC, with two exceptions: patients who refuse surgery, and patients for whom surgery would be considered as very high risk, although no clear consensus was reached on this second issue. […] The WSES committee for guidelines development is responsible for the continuous evaluation of evidence available about acute cholecystitis. […] We recommend laparoscopic cholecystectomy as the first-line treatment for patients with ACC. […] We recommend avoiding laparoscopic cholecystectomy in case of septic shock or absolute anaesthesiology contraindications.

• #26 Management of acute cholecystitis – Primary Care Notebook

  https://primarycarenotebook.com/pages/gastroenterology/management/management-of-acute-cholecystitis

  Conservative management:Initially acute cholecystitis is managed conservatively with bed-rest, gut-rest, analgesia with NSAIDs and opiates, anti-emetics, IV fluids and antibiotics: broad-spectrum antibiotics are used to cover the most common organisms found in the biliary tract. […] Surgical management:Cholecystectomy has been the treatment of choice for acute cholecystitis: laparoscopic cholecystectomy is considered the treatment of choice for most patients. […] laparoscopic cholecystectomy within 72 hours of admission is thought to reduce complications and hospital stay. […] urgent cholecystectomy is indicated in the following instances: fever, marked leukocytosis, or diffuse abdominal tenderness indicates possible necrosis, empyema, or rupture and surgery within 12 to 24 hours is indicated.

• #27 Acute Cholecystitis: Diagnostic Pitfall and Timing of Treatment | IntechOpen

  https://www.intechopen.com/chapters/54211

  Severe acute cholecystitis can show, in addition, damage of general conditions (organ dysfunction) which needs to treat. For these clinical-pathological conditions, urgent surgery is necessary: the type of surgical procedures is connected with pathological findings such as gangrenous or perforated cholecystitis, local or generalized peritonitis, involvement of adjacent organs. […] The first choice for acute cholecystitis is the laparoscopic approach with conversion rate ranging from 10 to 15%. […] In our experience, laparoscopic cholecystectomy morbidity in cirrhotic patients is slightly increased compared to non-cirrhotics. […] The last evolution in the surgical treatment of acute cholecystitis is the robotic approach. […] The comparison of the results of laparoscopic versus robotic cholecystectomy proves the complete equivalence between both the procedures regarding of safety and feasibility in all types of gallbladders pathology.

• #28 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00336-x

  In conclusion, the laparoscopic approach should be the first choice for cholecystectomy in child A and B patients. […] We recommend removing CBDS, either preoperatively, intraoperatively, or postoperatively, according to the local expertise and the availability of several techniques. […] We suggest considering NOM, i.e. best medical therapy with antibiotics and observation, for patients refusing surgery or those who are not suitable for surgery. […] Immediate laparoscopic cholecystectomy is superior to percutaneous transhepatic gallbladder drainage (PTGBD) in high risk patients with ACC. We recommend laparoscopic cholecystectomy as the first-choice treatment in this group of patients. […] We recommend performing gallbladder drainage in patients with ACC who are not suitable for surgery, as it converts a septic patient with ACC into a non-septic patient.

• #29 Cholecystitis (Gallbladder inflammation), Diagnosis & Treatment

  https://www.radiologyinfo.org/en/info/cholecystitis

  Your doctor may suggest: […] Treatment may include fasting, antibiotic medication and having a drainage tube placed in the gallbladder. However, because it can often reoccur, the most common treatment is to have surgery to remove your gallbladder. […] However, because the condition may come back often, your doctor may recommend you have your gallbladder removed using either: […] If you cannot have surgery, your doctor may drain bile from the gallbladder. This may be done by: […] Percutaneous cholecystostomy: This procedure is done by a radiologist. It places a tube through the skin directly into the gallbladder using ultrasound or CT guidance. Blocked or infected bile is removed to reduce inflammation. This procedure is typically done in patients who are too sick to have their gallbladder removed.

• #30 Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-percutaneous-cholecystostomy-as-treatment-for-articulo-S2255534X19300994

  In general terms, the most frequent indication for placing a PC is severe AC. […] Unlike that established in the TG13, the TG18 underline the fact that emergency gallbladder drainage can be carried out in grade II AC when laparoscopy is not available and there is an inadequate response to initial medical treatment, mainly in patients that present with poor general conditions. […] Despite the generalized acceptance of PC placement in patients with severe AC, and the reported evidence on a relatively low mortality rate, the best treatment option is still a subject of debate, given that some groups report an acceptable outcome with emergency LC in critically ill patients. […] The usefulness of initial conservative treatment, first placing a PC and then performing interval LC in patients with AC symptoms of more than 72-h progression, has also been studied.

• #31 Management of acute cholecystitis – Primary Care Notebook

  https://primarycarenotebook.com/pages/gastroenterology/management/management-of-acute-cholecystitis

  Percutaneous cholecystostomy: considered in an emergency situation in patients who are not suitable for cholecystectomy because of their general medical condition. […] appropriate treatment in accordance with the severity grade: Grade I (mild) acute cholecystitis: Laparoscopic cholecystectomy (Lap-C) at an early stage within 7 days (within 72 h is better) of onset of symptoms is recommended. […] Grade II (moderate) acute cholecystitis: urgent/early Lap-C if patient performance status is good and advanced Lap-C technique is available. […] Grade III (severe) acute cholecystitis: urgent/early biliary drainage. […] blood culture and/or bile culture is performed for Grade II (moderate) and III (severe) patients.

• #32 Acute Cholecystitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/acute-cholecystitis

  Surgery may be delayed when patients have an underlying severe chronic disorder (eg, cardiopulmonary disease or severe liver disease) that increases the surgical risks. In such patients, cholecystectomy is deferred until medical therapy stabilizes the comorbid disorders or until cholecystitis resolves. If cholecystitis resolves, cholecystectomy may be done 6 weeks later. Delayed surgery carries the risk of recurrent biliary complications. […] Percutaneous cholecystostomy is an alternative to cholecystectomy for patients at very high surgical risk, such as those who are older, those with acalculous cholecystitis, those with severe liver disease, and those in an intensive care unit because of burns, trauma, or respiratory failure.

• #33

  https://journals.lww.com/md-journal/fulltext/2020/02140/long_term_outcomes_of_acute_acalculous.30.aspx

  PC alone is reported to control up to 90% of AAC and has been used as a bridge therapy to cholecystectomy. […] Although recent studies suggest PC to be the definitive treatment method for AAC, its role as the definitive treatment option for AAC is controversial. […] In the present study, both surgical and non-surgical methods were successful in managing AAC, and overall therapeutic outcomes related to non-surgical group in patients with AAC were not inferior to those in the surgical group. […] The recurrence rate of acute cholecystitis after recovery from initial occurrence of AAC in the non-surgical group was 9.8%. […] In conclusion, recurrence occurred in 9.8% of patients with AAC treated with non-surgical management, and the treatment outcomes of non-surgical group were not inferior to those of the surgical group.

• #34 SciELO Brazil – ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT?

  https://www.scielo.br/j/abcd/a/GDzsqrkDRV7YSTvkHWDdWGP/

  The optimal treatment modality for patients with acute cholecystitis and high surgical risk should be individualized based on patient conditions and available expertise. […] Laparoscopic cholecystectomy remains an excellent option of treatment, mainly in hospitals in which percutaneous or endoscopic gallbladder drainage is not available. […] Percutaneous cholecystostomy and endoscopic gallbladder drainage should be performed only in well-equipped hospitals with experienced interventional radiologist and/or endoscopist. […] Cholecystostomy catheter should be removed after resolution of acute cholecystitis. However, in patients who have no clinical condition to undergo cholecystectomy, the catheter may be maintained for a prolonged period or even definitively. […] If the cholecystostomy catheter is maintained for an extended period of time several complications may occur, such as bleeding, bile leakage, obstruction, pain at the insertion site, accidental removal of the catheter, and recurrent acute cholecystitis.

• #35 Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-percutaneous-cholecystostomy-as-treatment-for-articulo-S2255534X19300994

  PC catheter removal should only be carried out after cystic duct permeability has been documented through cholangiography, if the catheter causes the patient discomfort, and if the patient is a candidate for definitive surgical treatment within a reasonable and opportune period of time to reduce the possibility of presenting with recurrent acute cholecystitis.

• #36 SciELO Brazil – ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT?

  https://www.scielo.br/j/abcd/a/GDzsqrkDRV7YSTvkHWDdWGP/

  The ideal waiting time between cholecystostomy and cholecystectomy has not yet been established and ranges from immediately after clinical improvement to months. […] EUS-GBD has emerged as a safe, efficacious, and minimally invasive option to treat AC in patients at high surgical risk. Several studies including a recent trial, comparing the efficacy of EUS-GBD and PC-GBD, have shown similar clinical success in both groups. However, the EUS-GBD group had lower rates of adverse events, unplanned readmissions, reinterventions, post-procedure pain, and length of hospital stay. […] The 2022 Guideline of the European Society of Gastrointestinal Endoscopy recommends that EUS-GBD should be preferred over PC-GBD due to lower rates of adverse events and reintervention.

• #37 A Review of Cholelithiasis and Cholecystitis for Pharmacists

  https://www.uspharmacist.com/article/a-review-of-cholelithiasis-and-cholecystitis-for-pharmacists

  For patients who decline surgery or for those who may be at higher surgical risk because of other comorbidities or advanced age, clinicians may elect to use oral bile acids. It is important to note that medical management of gallstones with pharmacologic therapies has diminished in the past few years. Medical therapy that is used alone or in combination may include oral bile salt therapy, such as UA, which is often used for x-ray-negative cholesterol gallstones in patients with normal gallbladder function. Extracorporeal shockwave lithotripsy may also be used, particularly in patients with noncalcified cholesterol gallstones who have normal gallbladder function. […] Treatment of cholecystitis often depends on the patients presentation, severity of the condition, and the presence or absence of complications. Uncomplicated cases are often treated on an outpatient basis, with appropriate analgesics; antibiotics, such as levofloxacin (500 mg po qd) and metronidazole (500 mg po bid), to provide prophylactic coverage of the most common organisms. Patients should receive vital follow-up care, and should be advised to contact their primary care doctor with any concerns. Complicated cases may require a surgical approach.

• #38 Gallstones (Cholelithiasis): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/7313-gallstones

  Occasionally, some people who need treatment for gallstones arent in a safe condition to have gallbladder removal surgery. In these cases, cholecystostomy is one alternative. This minor procedure places a catheter in your gallbladder to drain it. It can remove the gallstones currently inside. […] Healthcare providers dont prescribe medications for gallstones very often because they arent very effective. Medications like ursidol and chenodiol only work on smaller cholesterol stones that havent caused any complications yet. It can take months to years to dissolve them, and they often return. […] This isnt a practical way to treat gallstones for most people. But there may be limited circumstances where medications are helpful as a temporary or preventive measure. If youre not a good candidate for gallstone surgery, your healthcare provider will discuss their recommendations with you.

• #39 Surgical and Nonsurgical Management of Gallstones | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0515/p795.html

  Laparoscopic cholecystectomy is the most commonly performed abdominal surgery in industrialized countries, with almost 900,000 procedures performed annually in Europe and the United States. […] Antibiotic prophylaxis is not required in low-risk patients undergoing elective laparoscopic cholecystectomy, but it may reduce the incidence of wound infection in high-risk patients. […] For asymptomatic pigmented or calcified gallstones, no medical therapy aside from pain control is recommended. […] For cholesterol-containing gallstones, litholysis with oral agents is a historical option that is less often used in today’s clinical practice. […] When surgery is to be avoided, extracorporeal shock wave lithotripsy is a noninvasive therapeutic alternative for symptomatic patients. […] As laparoscopic techniques evolve, physicians continue to try to make surgery as minimally invasive as possible.

• #40 Cholecystitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholecystitis/symptoms-causes/syc-20364867

  If not treated, cholecystitis can lead to serious complications, such as gallbladder rupture. These can be life-threatening. Treatment for cholecystitis often involves surgery to remove the gallbladder. […] Cholecystitis is when your gallbladder is inflamed. Gallbladder inflammation can be caused by: […] Most often, cholecystitis is the result of hard particles of bile that can form in the gallbladder, called gallstones. Gallstones can block the tube that carries bile when it leaves the gallbladder. The tube is called the cystic duct. Bile builds up in the gallbladder, causing swelling and irritation. […] Cholecystitis that isn’t treated can cause tissue in the gallbladder to die. This is called gangrene. This most common complication mainly affects older people, those who wait to get treatment and those with diabetes. Gangrene can lead to a tear in the gallbladder. Or it may cause the gallbladder to burst. […] Treatment of acute calculous cholecystitis.

• #41

  https://www.nhs.uk/conditions/gallstones/complications/

  Acute cholecystitis is usually first treated with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder. […] The operation can be more difficult when performed as an emergency, and there’s a higher risk of it being converted to open surgery. […] Sometimes a severe infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone don’t always treat these and they may need to be drained. […] If this happens, you may need antibiotics given directly into a vein (intravenous antibiotics), and surgery may be required to remove a section of the lining if part of it becomes severely damaged.

• #42 Acute Cholecystitis – Zero To Finals

  https://zerotofinals.com/surgery/general/acutecholecystitis/

  Patients with suspected acute cholecystitis need emergency admission for investigations and management. […] Conservative management involves: […] IV fluids […] Antibiotics (as per local guidelines) […] NG tube if required for vomiting. […] Endoscopic retrograde cholangio-pancreatography (ERCP) can be used to remove stones trapped in the common bile duct. […] Cholecystectomy (removal of the gallbladder) is usually be performed during the acute admission, within 72 hours of symptoms. In some cases, it may be delayed for 6-8 weeks after the acute episode to allow the inflammation to settle. […] Gallbladder empyema refers to infected tissue and pus collecting in the gallbladder. Management involves IV antibiotics and one of two main options: […] Cholecystectomy (to remove the gallbladder) […] Cholecystostomy (inserting a drain into the gallbladder to allow the infected contents to drain).

• #43

  https://step2.medbullets.com/gastrointestinal/120163/acute-cholecystitis

  First-line […] supportive care […] intravenous fluids […] electrolyte repletion […] analgesia […] intravenous antibiotics […] non-emergent cholecystectomy […] indication […] usually done within 72 hours […] emergent cholecystectomy […] indication […] generalized peritonitis […] perforated cholecystitis or gangrenous cholecystitis […] Second-line […] percutaneous drainage […] indication […] medically unstable for cholecystectomy

• #44 Acute cholecystitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000264.htm

  If you have severe belly pain, seek medical attention right away. […] In the emergency room, you’ll be given fluids through a vein. You also may be given antibiotics to fight infection. […] Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder. […] Nonsurgical treatment includes: […] Antibiotics you take at home to fight infection […] Low-fat diet (if you are able to eat) […] Pain medicines. […] You may need emergency surgery if you have complications such as: […] Tissue death (gangrene) of the gallbladder […] A hole that forms in the wall of the gallbladder (perforation) […] Inflamed pancreas (pancreatitis) […] Persistent bile duct blockage […] Inflammation of the common bile duct. […] If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery.

• #45 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://www.mdpi.com/2077-0383/13/9/2695

  Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7–10 days from symptom onset. […] In the course of AC, concomitant gallstone-related complications may occur, such as choledocholithiasis, acute cholangitis, and biliary pancreatitis. In such cases, additional diagnostic workup and adequate therapeutic procedures must be performed. […] The first therapeutic measures consist of fasting, fluid intravenous infusion, and antimicrobial therapy. Furthermore, analgesics should be administered if needed.

• #46 Surgical and Nonsurgical Management of Gallstones | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0515/p795.html

  In pregnant women with symptomatic gallstones, the initial management is supportive care, which is usually successful. […] Although surgery is the treatment of choice for acute cholecystitis, it is associated with increased mortality in older persons. […] In patients who are critically ill with gallbladder empyema and sepsis, cholecystectomy can be life threatening.

• #47 SciELO Brazil – ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT?

  https://www.scielo.br/j/abcd/a/GDzsqrkDRV7YSTvkHWDdWGP/

  Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases. In these critically ill patients, percutaneous cholecystostomy or endoscopic ultrasound gallbladder drainage may be a temporary therapeutic option, a bridge to cholecystectomy. […] The main conclusions are: a) AC patients with elevated surgical risk must be preferably treated in tertiary hospitals where surgical, radiological, and endoscopic expertise and resources are available; b) The optimal treatment modality for high-surgical-risk patients should be individualized based on clinical conditions and available expertise; c) Laparoscopic cholecystectomy remains an excellent option of treatment, mainly in hospitals in which percutaneous or endoscopic gallbladder drainage is not available; d) Percutaneous cholecystostomy and endoscopic gallbladder drainage should be performed only in well-equipped hospitals with experienced interventional radiologist and/or endoscopist; e) Cholecystostomy catheter should be removed after resolution of AC. However, in patients who have no clinical condition to undergo cholecystectomy, the catheter may be maintained for a prolonged period or even definitively; f) If the cholecystostomy catheter is maintained for a long period of time several complications may occur, such as bleeding, bile leakage, obstruction, pain at the insertion site, accidental removal of the catheter, and recurrent AC; g) The ideal waiting time between cholecystostomy and cholecystectomy has not yet been established and ranges from immediately after clinical improvement to months. h) Long waiting periods between cholecystostomy and cholecystectomy may be associated with new episodes of acute cholecystitis, multiple hospital readmissions, and increased costs.

• #48 Evidence-based Guidelines for the Management of Acute Cholecystitis

  https://www.pajtcces.com/abstractArticleContentBrowse/PAJT/31337/JPJ/fullText

  It is recommended that all patients diagnosed with acute cholecystitis receive antibiotics to prevent progressive GB inflammation, development of secondary infection, or sepsis. […] For the surgical management of diagnosed acute cholecystitis, the patients underlying comorbidities and medications are what ultimately control the timing of surgery. […] Laparoscopic cholecystectomy is currently the procedure of choice for surgical management of acute cholecystitis due to the decrease in intraoperative complications, reduced patient time spent in the hospital, and reduced time to baseline function. […] Percutaneous cholecystostomy tube (PCT) placement is an available option for patients diagnosed with acute calculous or acalculous cholecystitis who are too high of a surgical or anesthesia risk in the setting of antibiotic failure. […] If chosen when truly a nonsurgical candidate, PCT should optimally be performed early, as it lowers procedure-related bleeding and LOS compared to late placement. […] Following GB drainage, a patients care plan depends on the resolution of clinical symptoms and individualized surgical plans.

• #49 Cholecystitis (Gallbladder Inflammation): Symptoms, Signs, Treatment, Diet

  https://www.emedicinehealth.com/cholecystitis/article_em.htm

  Is There a Special Diet for Cholecystitis or After a Cholecystectomy? For individuals with cholecystitis, experts suggest a low-fat diet with lean protein sources like fish or poultry. Avoid rapid weight loss and low food intake(less than 800 calories per day) since this can lead to gallstones. After a cholecystectomy, patients should eat smaller and more frequent meals that include: Lean protein sources, Fat-free dairy products, Vegetables, Whole grains, Fruits. […] How Can I Prevent Cholecystitis? You can reduce the risk of getting cholecystitis by slow weight loss, as rapid weight loss increases the risk of developing gallstones. Avoid obesity and a diet high in fat, as a diet high in fiber and low in fat helps to inhibit bile cholesterol from forming gallstones.

• #50 Acute Cholecystitis: Symptoms, Causes, & Treatment – Southlake General Surgery

  https://www.southlakegeneralsurgery.com/acute-cholecystitis-symptoms-causes-treatment/

  For many patients, surgical intervention, such as laparoscopic cholecystectomy, is the preferred treatment for acute cholecystitis. […] In some cases, particularly for high-risk patients or those with complications such as gallbladder perforation, alternative surgical options may be considered. These include open surgery or percutaneous cholecystostomy, a procedure in which a small tube is inserted through the abdominal wall into the gallbladder to drain bile and other fluids, thereby relieving pressure and pain. […] The prognosis for acute cholecystitis is generally good with appropriate treatment. Most patients experience complete remission within 1-4 days, though 25%-30% of patients either develop complications or require emergency surgery.

• #51 Acute Cholecystitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459171/

  Patients with acalculous cholecystitis are often managed in the intensive care unit and may undergo an initial aspiration procedure until they are fit to undergo formal surgery. Since many of these patients have high comorbidity, monitoring them is critical. Educating the patient and family is vital since the condition does carry a high mortality. The other group of patients who may have a prolonged stay are those with a bile duct stone. These patients require an ERCP prior to cholecystectomy. Again ERCP is not a benign procedure, and patients need to be educated about the procedure and potential complications. […] For patients with uncomplicated acute cholecystitis, the prognosis is excellent. The mortality rates are very low. Perforation or gangrene of the gallbladder may occur in delayed cases. Patients with acalculous cholecystitis have high mortality varying from 20-50%.

• #52 Cholecystitis (Gallbladder Inflammation): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15265-gallbladder-swelling–inflammation-cholecystitis

  Cholecystitis is treated immediately in the hospital. Treatment begins with supportive care, including: […] The definitive treatment for cholecystitis is surgery to remove your gallbladder. […] If you’re delaying or foregoing surgery, you might have: […] To prevent the effects of repeat episodes of gallbladder inflammation, healthcare providers recommend surgery to remove your gallbladder (cholecystectomy). […] Most people have excellent outcomes. Cholecystitis that goes untreated may lead to dangerous complications.

• #53 Cholecystitis (gallbladder inflammation) | healthdirect

  https://www.healthdirect.gov.au/cholecystitis-gallbladder-inflammation

  Cholecystitis needs to be treated in hospital. […] Treatment usually involves: fasting (not eating and drinking), intravenous (IV) fluids fluids given through a drip, antibiotics, pain-relief medicines, surgery to remove your gallbladder. […] Surgery to remove your gallbladder is called a cholecystectomy. This is standard treatment if your cholecystitis is caused by gallstones. […] Your gallbladder may be removed with a procedure called a laparoscopic cholecystectomy. This is a type of keyhole surgery. […] If there are complications during keyhole surgery, your doctors may need to switch to an open operation. […] After the operation, bile will flow straight from your liver to your small intestine. You can live a normal life without your gallbladder.

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