Review of clinical experience with acute cholecystitis on the development ofsubsequent gallstone-related complications

Abstract

Background/aim: Recently, surgery during admission has been advocated for acute cholecystitis, rather than delayed surgery after conservative treatment. This study was designed to perform early surgeries and analyze the criteria used for conservative management followed by delayed surgery. Materials and methods:After implementation of a study with the aim of performing early surgery, a retrospective review using a prospective database during the period of June 2009 to June 2011 was established. Early surgery during index hospitalization was offered to all patients, except those having criteria for conservative management.Results: There were 118 patients admitted for acute cholecystitis. Early and delayed surgeries were performed for 18 (15%) and 23 (20%) patients, respectively. Percutaneous cholecystostomy was performed for 10 (8%) patients with a success rate of 90% and significantly higher length of hospital stay (P = 0.001). Gallstone-related complications developed in 33 (28%) patients, causing significantly higher readmission rates (P = 0.001). Of the patients, 34 (29%) were neither operated on nor had complications. The subsequent cholecystectomy rate was calculated as 35%. The overall mortality rate was 1.7% for all groups. Conclusion:Although surgical treatment of acute cholecystitis, either by early or delayed surgery, has some specific morbidity and mortality, it should be kept in mind that conservative treatment modalities a have higher rate of recurrences and subsequent complications, which all cause additional morbidity and mortality in patients.

Systematic review of antibiotic treatment for acute calculous cholecystitis

“…Twelve articles described randomized clinical trials (RCTs), of which four reported on two trials, and there were four prospective studies and ten retrospective studies ( Table ). Only one randomized trial compared antibiotic treatment with conservative management without antibiotics.…”

“…Only one randomized trial compared antibiotic treatment with conservative management without antibiotics. Twenty studies, including 11 RCTs and one prospective study, compared initial treatment with antibiotics and (early) cholecystectomy. Five were non‐comparative cohort studies that described the fate of patients initially treated with antibiotics.…”

“…The definition of ACC varied greatly between studies. Most studies used their own definition, which varied from clinical symptoms alone to detailed ultrasonographic findings ( Table S2 , supporting information).…”

“…Sixteen studies evaluated the need for emergency intervention after antibiotic treatment; this ranged from 0 to 44·1 per cent. The pooled event rate for the need for emergency intervention from six randomized studies was 15 (95 per cent c.i.…”

“…Fourteen studies reported recurrence of ACC following antibiotic treatment; this varied between 0 and 37 per cent. The overall pooled event rate from the eight randomized studies was 10 (95 per cent c.i.…”