Advances in the management of acute cholecystitis

Annals of Gastroenterological Surgery

Sameer Hirji¹  Stanley W. Ashley¹  Danny Mou²  Tomas Tesfasilassie³ 

[1] Department of Surgery Harvard Medical School Brigham and Women’s Hospital Boston Massachusetts;Harvard Medical School CRICO Scholar in Quality and Safety Brigham and Women's Hospital Boston Massachusetts;School of Medicine University of California San Francisco California;

关键词: cholecystectomy;    cholecystitis;    cholelithiasis;    laparoscopic cholecystectomy;    percutaneous cholecystostomy;   

DOI  :  10.1002/ags3.12240

来源: DOAJ

【 摘 要 】

Abstract The diagnosis and management of acute cholecystitis (AC) continues to evolve. Among the most common surgically treated conditions in the USA, appropriate diagnosis and management of AC require astute clinical judgment and operative skill. Useful diagnostic and grading systems have been developed, most notably the Tokyo guidelines, but some recent clinical validation studies have questioned their generalizability to the US population. The timing of surgical intervention is another area that requires further investigation. US surgeons traditionally pursue laparoscopic cholecystectomy (LC) for AC patients with symptoms onset <72 hours, but for patients with symptoms over 72 hours, surgeons often elect to treat the patients with antibiotics and delay LC for 4‐6 weeks to permit the inflammation to subside. This practice has recently been called into question, as there are data suggesting that LC even for AC patients with over 72 hours of symptoms confers decreased morbidity, shorter length of stay, and reduced overall healthcare costs. Finally, the role of percutaneous cholecystostomy (PC) needs to be better defined. Traditional role of PC is a temporizing measure for patients who are poor surgical candidates. However, there are data suggesting that in AC patients with organ failure, PC patients suffered higher mortality and readmission rates when compared with a propensity‐matched LC cohort. Beyond diagnosis, the surgical management of AC can be remarkably challenging. All surgeons need to be familiar with best‐practice surgical techniques, adjunct intra‐operative imaging, and bail‐out options when performing LC.

【 授权许可】

Unknown