Urgent and early cholecystectomy for acute gallbladder disease

Abstract

A retrospective study of 645 cholecystectomies performed in a surgical unit over a 10-year period is presented, of which 236 were carried out during an acute admission. Of these 236 cholecystectomies, 195 were performed for acute cholecystitis and 41 for acute gallstone pancreatitis. In the acute cholecystitis group the proportion of patients over 70 years of age was significantly higher (35 per cent) than the corresponding elective group (10.3 per cent). Of those patients presenting with complications (empyema, gangrene, perforation, and biliary peritonitis) 51 per cent were over the age of 70 years. The most valuable investigation in the diagnosis of acute cholecystitis was ultrasound carried out within the first 48 h, with positive results in 83 per cent of those examined. The mortality for elective cholecystectomy was 0.5 per cent rising to 4.7 per cent in the urgent/early cholecystectomy group. The mean age of the 11 patients who died was 76 years, 8 of these patients being over the age of 70 years. The mortality in the subgroup of patients over 70 years was 10 per cent rising to 20 per cent in the over-80 age group. There were no deaths in the acute gallstone pancreatitis group. We conclude that emergency or early cholecystectomy is a safe procedure in patients under 70 years of age. However, patients over 70 years present with more serious complications of acute gallbladder disease which necessitate urgent surgery. We therefore recommend early cholecystectomy in patients over 70 years despite the high attendant mortality.

Results of Surgical Treatment for Gallbladder Empyema May Be Analogous to Those of the Remaining Types of Acute Cholecystitis

“…7-10]. ranging from 8.8 [7] to 41% [8] of the total number of ACs receiving surgical treatment. One obvious factor is the different criteria in these cases for diagnosis and therapy.…”

The Study of Gall Bladder Perforation (2005-2015)

“…Gall bladder perforation presentation sometimes does not differ from uncomplicated acute cholecystitis thus resulting in high morbidity and mortality. The establishment of early cholecystectomy and improvement of antibiotics therapy regimen have reduced the risk of gall bladder perforation in acute cholecystitis to 0.8-3.2% today [1]. Clinical presentation ranges from acute general peritonitis to benign nonspecific abdominal symptoms.…”

Complications and Late Outcome following Percutaneous Drainage of the Gallbladder in Acute Calculous Cholecystitis

“…We published our first results in 1988 [7]. The mortality rate after surgery performed within 48 h of the acute attack has been up to 19% in elderly, high-risk patients with coexisting disease [5, 8]. However, in recent years far better results have been achieved with almost zero mortality [9, 10, 11, 12, 13, 14, 15].…”