Radical or expectant therapy of acute cholecystitis

Invited commentary

“…However, the mortality of conservative treatment for acute cholecystitis ranges from 4-24% and is particularly high (20-75%) if the gallbladder perforates, which it does in 3-12% of patients. As a result, the role of early operation for acute cholecystitis has been critically examined in several careful clinical studies [1][2][3][4][5][6][7] and, more recently, in prospective controlled trials [8][9][10]. The clear advantages of early operation are as follows:…”

“…The timing of operation in acute cholecystitis has been studied in 3 randomized trials, one Swedish [1], one British [2], and one Finnish [3]. Direct comparisons between these 3 trials are not altogether meaningful because of the differences in their design.…”

“…Whether cholecystectomy is more difficult in the acute phase or after the inflammation has subsided is a question on which leading surgeons have had firm opinions without any data whatsoever. Two of the trials [1,2] concluded that acute operations were more difficult, whereas the third [3] concluded the opposite. Surgeons in training more often met with difficulties in acute than in delayed operations…”