Carsten Gutt1, Simon Schläfer2. 1. Klinik für Allgemein,- Viszeral,- Thorax- und Gefäßchirurgie, Klinikum Memmingen, Bismarckstraße 23, 87700, Memmingen, Deutschland. carsten.gutt@klinikum-memmingen.de. 2. Klinik für Allgemein,- Viszeral,- Thorax- und Gefäßchirurgie, Klinikum Memmingen, Bismarckstraße 23, 87700, Memmingen, Deutschland.
Abstract
BACKGROUND: The treatment of acute cholecystitis is based on the German S3 guidelines on "Prophylaxis, diagnosis and treatment of gallstones", which was updated in 2018. If the patient has no contraindications for surgery, early laparoscopic cholecystectomy is the treatment of choice. OBJECTIVE: Current meta-analyses and studies confirm that for most patients the optimal period of time for surgical treatment is the first 24 h after hospitalization; however, there is an ongoing controversial discussion on how strictly the 24 h rule should be adhered to and under which circumstances it may be valid to deviate from it. MATERIAL AND METHOD: A systematic analysis of the current literature and a clinical evaluation were carried out. RESULTS: For the diagnosis of an acute cholecystitis, laparoscopic cholecystectomy should be carried out within the first 24 h after hospitalization regardless of the age and comorbidities of the patient as well as the severity of inflammation. If there is no special emergency situation, under certain circumstances surgery can be performed in the next day's program. DISCUSSION: This recommendation for early surgery for high-risk patients has so far been controversially discussed; however, current studies confirm that the advantages of early surgery outweigh the disadvantages also for this group of patients. The surgical risk should be individually assessed and be included in the treatment decision.
BACKGROUND: The treatment of acute cholecystitis is based on the German S3 guidelines on "Prophylaxis, diagnosis and treatment of gallstones", which was updated in 2018. If the patient has no contraindications for surgery, early laparoscopic cholecystectomy is the treatment of choice. OBJECTIVE: Current meta-analyses and studies confirm that for most patients the optimal period of time for surgical treatment is the first 24 h after hospitalization; however, there is an ongoing controversial discussion on how strictly the 24 h rule should be adhered to and under which circumstances it may be valid to deviate from it. MATERIAL AND METHOD: A systematic analysis of the current literature and a clinical evaluation were carried out. RESULTS: For the diagnosis of an acute cholecystitis, laparoscopic cholecystectomy should be carried out within the first 24 h after hospitalization regardless of the age and comorbidities of the patient as well as the severity of inflammation. If there is no special emergency situation, under certain circumstances surgery can be performed in the next day's program. DISCUSSION: This recommendation for early surgery for high-risk patients has so far been controversially discussed; however, current studies confirm that the advantages of early surgery outweigh the disadvantages also for this group of patients. The surgical risk should be individually assessed and be included in the treatment decision.
Authors: Rouf Gul; Rayees Ahmad Dar; Riyaz Ahmad Sheikh; Nazir Ahmad Salroo; Adnan Rashid Matoo; Sabiya Hamid Wani Journal: N Am J Med Sci Date: 2013-07
Authors: Charlotte S Loozen; Hjalmar C van Santvoort; Peter van Duijvendijk; Marc Gh Besselink; Dirk J Gouma; Grard Ap Nieuwenhuijzen; Johannes C Kelder; Sandra C Donkervoort; Anna Aw van Geloven; Philip M Kruyt; Daphne Roos; Kirsten Kortram; Verena Nn Kornmann; Apollo Pronk; Donald L van der Peet; Rogier Mph Crolla; Bert van Ramshorst; Thomas L Bollen; Djamila Boerma Journal: BMJ Date: 2018-10-08