Management

Acute cholecystitis

• in all patients with acute cholecystitis, give analgesia, fluid resuscitation, and - if infection is suspected -antibiotics as required. (1)
• the National Institute for Health and Care Excellence (NICE) states that surgery should be performed within a week of diagnosis where resources allow (2)
• severe inflammation of the gallbladder and its surroundings increases the difficulty of a laparoscopic cholecystectomy and the frequency of postoperative complications (3)

Chronic cholecystitis

• preferred treatment for chronic cholecystitis is elective laparoscopic cholecystectomy:
  • has a low morbidity rate and can be performed as an outpatient surgery
• open cholecystectomy is also an option however requires hospital admission and longer recovery time:
  • indicated in patients who are not laparoscopic candidates such as those with extensive prior surgeries and adhesions (4)

Patients who are not surgical candidates or who prefer not to undergo surgery can be closely observed and managed conservatively:

• a low-fat diet can help reduce the frequency of symptoms
• in patients with symptomatic cholelithiasis, the use of ursodeoxycholic acid has been shown to decrease rates of biliary colic and acute cholecystitis (5)

Referencen:

1. Okamoto K, Suzuki K, Takada T, et al. Tokyo guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):55-72.

2. National Institute for Health and Care Excellence. Gallstone disease: diagnosis and management. October 2014 [internet publication].

3. Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):73-86.

4. Jones M et al. Chronic Cholecystitis. Treasure Island (FL): StatPearls Publishing. 2024 Jan.

5. Guarino MP, Cocca S, Altomare A, Emerenziani S, Cicala M. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol. 2013 Aug 21;19(31):5029-34.