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World J Gastrointest Surg. May 27, 2017; 9(5): 118-126
Published online May 27, 2017. doi: 10.4240/wjgs.v9.i5.118
Acute calculous cholecystitis: Review of current best practices
Carlos Augusto Gomes, Cleber Soares Junior, Salomone Di Saverio, Massimo Sartelli, Michael Denis Kelly, Camila Couto Gomes, Felipe Couto Gomes, Livia Dornellas Corrêa, Camila Brandão Alves, Samuel de Fádel Guimarães
Carlos Augusto Gomes, Cleber Soares Junior, Surgery Department, Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde Juiz de Fora, Juiz de Fora, MG 36033, Brazil
Salomone Di Saverio, Trauma Surgery Unit, Maggiore Hospital, 40121 Bologna, Italy
Massimo Sartelli, Department of Surgery, Macerata Hospital, 62100 Bologna, Italy
Michael Denis Kelly, Acute Surgical Unit, Canberra Hospital, Garran, ACT 2605, Australia
Camila Couto Gomes, Surgery Department, Hospital Governador Israel Pinheiro (HGIP - IPSEMG), Belo Horizonte, MG 30130-110, Brazil
Felipe Couto Gomes, Livia Dornellas Corrêa, Camila Brandão Alves, Samuel de Fádel Guimarães, Internal Medicine Unit, Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde Juiz de Fora, Juiz de Fora, MG 36033, Brazil
Author contributions: All authors had participated sufficiently in the work to take public responsibility for appropriate portions of the content according to ICMJE; Gomes CA, Junior CS, Di Saverio S, Sartelli M and Kelly MD had participated in the conception and design, acquisition, analysis, and interpretation of data, revising it critically and ensuring the accuracy and integrity of manuscript; Gomes CC, Gomes FC, Corrêa LD, Alves CB and Guimarães SF had participated in drafting, acquisition, analysis, and interpretation of data; revising it critically and ensuring the accuracy and integrity of manuscript; all authors have participated in the final version approval of manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carlos Augusto Gomes, MD, PhD, Associate Professor, Surgery Department, Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde Juiz de Fora, Alameda Salvaterra, 200 - Salvaterra, Juiz de Fora, MG 36033, Brazil. caxiaogomes@gmail.com
Telephone: +55-32-21015000
Received: January 22, 2017
Peer-review started: January 23, 2017
First decision: February 17, 2017
Revised: March 11, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: May 27, 2017
Abstract

Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.

Keywords: Cholecystitis, Cholelithiasis, Biliary stones, Cholecystectomy, Laparoscopy

Core tip: This paper presented herein is a practical and comprehensive review of the acute cholecystitis. This common intra-abdominal infection can proceed to severe complications due to its natural history and requires operative treatment. Surgeons should keep in mind some basic concepts to allow them to make correct decisions about ideal operative strategy including timing.