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Emergency Laparoscopy pp 7–25Cite as

Acute Calculous Cholecystitis

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Abstract

Acute calculous cholecystitis is one of the most common surgical conditions. About one third of all cholecystectomies are performed for this disease. Nevertheless, many aspects about its management are controversial. The literature about acute calculous cholecystitis clarifies that laparoscopic surgery is the gold standard treatment for this disease. In particular, early laparoscopic cholecystectomy appears to be more advantageous than delayed surgery, and surgery should be performed as soon as possible. However, a few particular conditions deserve separate considerations. In fact, the management of the disease should consider its severity and the general status of the patient; but we do not have reliable instruments to stratify the surgical risk and choose an appropriate treatment for each situation. A delayed approach, often preceded by gallbladder drainage (cholecystostomy), has been advocated for severe (empyema, gangrenous or perforated) cholecystitis. Yet, many studies suggest that early cholecystectomy is still the best possible treatment for it, and cholecystostomy cannot be considered a standard procedure. Old age is a relevant risk factor and the best treatment for elderly and frail patients is not defined. The endoscopic gallbladder drainage procedures appear to be promising in poor surgical candidates but they are not widely available, and more studies are needed.

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Authors and Affiliations

  1. AUSL Viterbo, Ospedale San Giovanni Decollato Andosilla, via Ferretti 169, 01033, Civita Castellana, VT, Italy

    Fabio Cesare Campanile & Domenico Giannotti

  2. Department of General Surgery, Azienda ULSS19 del Veneto, Adria, (RO), Italy

    Ferdinando Agresta

  3. Montichiari Surgery Department, ASST Spedali Civili di Brescia, via G. Ciotti 154, 25018, Montichiari, BS, Italy

    Nereo Vettoretto

  4. Virginia Commonwealth University, Richmond, VA, USA

    Rao Ivatury

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  1. Fabio Cesare Campanile
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  2. Domenico Giannotti
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  3. Ferdinando Agresta
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  4. Nereo Vettoretto
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  5. Rao Ivatury
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Correspondence to Fabio Cesare Campanile .

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  1. Department of General Surgery, Azienda ULSS19 del Veneto, Adria, Italy

    Ferdinando Agresta

  2. AUSL Viterbo, Ospedale San Giovanni Decollato Andosill, Civita Castellana, Italy

    Fabio Cesare Campanile

  3. Dept of Morfology, Surgery and Experime, School of Medicine, Univ of Ferrara, Ferrara, Italy

    Gabriele Anania

  4. Careggi University Hospital, Florence, Italy

    Carlo Bergamini

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Campanile, F.C., Giannotti, D., Agresta, F., Vettoretto, N., Ivatury, R. (2016). Acute Calculous Cholecystitis. In: Agresta, F., Campanile, F., Anania, G., Bergamini, C. (eds) Emergency Laparoscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-29620-3_2

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