Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Really Safe? Acute cholecystitis: delayed surgery or observation. A randomized clinical trial. A randomized study of cholecystectomy with and without drainage. Symptomatic, non-complicated gallbladder stone disease. Operation or observation? A randomized clinical study. Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. The conduct of cholecystectomy: incision, drainage, bacteriology and postoperative complications. A Randomized Controlled Study of Uncomplicated Gallstone Disease with a 14-Year Follow-Up Showed that Operation Was the Preferred Treatment Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Routine Administration of Antibiotics to Patients Suffering Accidental Gallbladder Perforation During Laparoscopic Cholecystectomy is not Necessary Laparoscopic Cholecystectomy for Acute Cholecystitis: Prospective Trial Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: Non-operative management is an option in some patients Suction drainage of the gallbladder bed does not prevent complications after cholecystectomy: A random control clinical trial Effectiveness of Prophylactic Antibiotics in a Population-Based Cohort of Patients Undergoing Planned Cholecystectomy Determinants of postoperative infection after laparoscopic cholecystectomy. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial Expectant management of patients with gallbladder stones diagnosed at planned investigation. A prospective 5- to 7-year follow-up study of 153 patients. Conservative treatment for acute cholecystitis: clinical and radiographic predictors of failure.
Abstract . The prospect ively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up . The aim of this study was to compare the results of laparoscopic cholecystectomy ( LC ) for acute cholecystitis with that for routine symptomatic gallbladders . The preoperative , intraoperative , and postoperative parameters of 424 routine ( noninflamed ) LCs and 54 LCs for acutely inflamed gallbladders were compared under the “ intention to treat ” principle . Operating time was longer in the inflamed group ( median 97 minutes versus 75 minutes;p < 0.0001 ) . Significantly more adhesions ( 20 % versus 8 % ) , more blood loss ( 48 % versus 19 % ) , a higher incidence of bile spillage ( 28 % versus 12 % ) , and lost stones ( 19 % versus 8 % ) were encountered in patients with acute cholecystitis . Common bile duct ( CBD ) injuries were also more frequent in that group ( 5.5 % versus 0.2%;p = 0.005 ) . The rate of conversion to open surgery was higher than with routine LCs ( 13 % versus 4 % ) . There were two deaths in the routine LC group and none in the acutely inflamed group . There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements . Patients with acute cholecystitis stayed only 1 day longer ( median 4 days versus 3 days ) in hospital . The quality of life scores indicate return to almost normal values by the 14th postoperative day . Long-term follow-up ( 1–3 years ) did not reveal any delayed clinical adverse effects . In summary , LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders . If successfully performed , it has definite benefit for the patient in terms of better postoperative recovery . The trade-off is that the risk of CBD injury is significantly higher BACKGROUND The aim of the present study was to compare the risk of observation versus that of cholecystectomy in acute cholecystitis in patients r and omly allocated to delayed operation or conservative treatment . METHODS One-hundred- and -eighty patients were considered for participation in the study ; 71 were excluded according to predefined criteria and 45 did not join for other reasons . The remaining 64 patients were r and omized to cholecystectomy ( n = 31 ) or observation ( n = 33 ) . R and omized patients were contacted regularly and followed up for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Gallstone-related complications or emergency admissions for pain occurred in six patients in the operation group ( 19 % ; 95 % CI 5%-33 % ) and in 12 patients ( 36 % ; 9 % CI 20%-53 % ) in the observation group . Twenty-seven of 31 patients r and omized to cholecystectomy had a  cholecystectomy  at a median of 3.6 months after r and omization , and , of these , 3 ( 11 % ; 95 % CI 0%-23 % ) suffered a major and 7 ( 26 % ; 95 % CI 9%-42 % ) a minor complication . Ten patients r and omized to observation later had their gallbladders removed , 1 ( 10 % ; 95 % CI 0%-29 % ) patient had a major and 1 ( 10 % ; 95 % CI 0%-29 % ) a minor complication . We found no mortality after cholecystectomy . CONCLUSIONS We found a certain risk of subsequent gallstone-related events following conservative treatment of acute cholecystitis , but the data also show that cholecystectomy should not necessarily be compulsory after acute cholecystitis Routine drainage of the bed of the gallbladder following  cholecystectomy  remains controversial . A prospect ively r and omized series of 100 instances of cholecystectomy for chronic and subsiding acute cholecystitis are review ed . Postoperative fever was lowered , the need for dressing changes was virtually eliminated and hospital stay was shortened in patients who did not undergo drainage . No complications attributable to drain avoidance were seen BACKGROUND Cholecystectomy has been recognized as the treatment of choice for symptomatic gallbladder stone disease . Not all patients are cured by an operation and the reason for having the gallbladder removed may rest on common practice rather than evidence -based medicine . The aim was to compare cholecystectomy with observation ( watchful waiting ) in patients with uncomplicated symptomatic GBS disease . Three-hundred- and -thirty-eight patients were considered for participation in the study ; 45 patients were excluded according to predefined criteria and 156 did not join for other reasons . The remaining 137 were r and omized to cholecystectomy ( n = 68 ) or non-operative , expectant treatment ( n = 69 ) . METHODS R and omized patients were contacted regularly and followed for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Eight of the patients r and omized to cholecystectomy did not undergo operation , while 35 of the patients r and omized to observation later had their gallbladders removed . The cumulative risk of having a cholecystectomy seemed to level off after 4 years . Gallstone-related complications occurred in 3 patients in the observation group , 1 in the operation group and 5 of 201 excluded patients . After cholecystectomy , 16 of 222 patients had a major complication and 10 a minor . CONCLUSIONS We found that non-operative expectant treatment carries a low risk of complications . Patients should be informed that watchful waiting is a safe option The results of cholecystectomy in terms of symptomatic improvement were prospect ively evaluated in 124 unselected gall stone patients interviewed before and two years after elective surgery . Indications for cholecystectomy were biliary pain ( n = 65 ) , previous complications of gall stone disease ( n = 52 ) , and flatulent dyspepsia ( n = 7 ) . At two years 93 patients could be re-evaluated , of whom only 49 ( 53 % ) were completely symptom free . Postcholecystectomy symptoms occurring in the remaining 44 patients were mainly flatulent dyspepsia ( which had relapsed in 22 of 46 patients who suffered it preoperatively ) , dull abdominal pain or diarrhoea . Incisional hernia was present in five patients and one had recurrence of pain because of retained common bile duct stones . Symptomatic cures after cholecystectomy decreased with the duration of the preoperative history . The results reconfirm that cholecystectomy  eradicates specific symptoms and complications of gall stone disease , but they also show that nearly one half of operated patients are dissatisfied with the procedure because of mild but distressing ' postcholecystectomy ' symptoms . These are probably caused by previously undiagnosed functional gut disease associated with , but unrelated to , gall stones . A systemic approach to multisymptomatic patients with gall stones is recommended The benefits of some ancillary techniques of cholecystectomy are exaggerated by retrospective study of selected patients . Therefore , the authors performed a prospect i ve , r and omized study of 100 consecutive patients who underwent simple elective cholecystectomy for chronic cholecystitis and cholelithiasis . No patient was excluded because of incomplete hemostasis or fear of bile leakage . The frequency of pulmonary complications and wound infections was independent of the type of incision -- vertical or subcostal . Peritoneal drainage was found to be unnecessary . Short-term drainage may increase the frequency of postoperative fever , but did not increase pulmonary complications or wound infections . In these patients , intra-abdominal sepsis is rare ; wound infections were uncommon and the gallbladder bile was usually sterile and not the cause of postoperative infection Background / Aims : Cholecystectomy is considered the treatment of choice for symptomatic gallstone disease . Some patients abstain from surgery and provide the opportunity to study the natural history of cholelithiasis . The aim of the present study was to examine the feasibility and safety of observation after extended long-term follow-up in a r and omized controlled trial . Methods : A total of 137 patients ( 40.5 % of those assessed ) were r and omized to observation or cholecystectomy and followed up for 14 years . The prevalence of symptomatic events or major complications after treatment was the primary end point . A secondary end point was completion of r and omized treatment . Results : There were no differences in outcome between the observation group and the surgical group ( p = 0.298 ) . Virtually no  cholecystectomy  was performed after 5 years of follow-up , and no clear escalation in the severity of the disease was observed . A total of 50.7 % of patients from the observation group and 88.2 % from the surgical group underwent surgery . The group r and omized to surgery completed their design ated treatment significantly more often ( p < 0.001 ) , especially among patients younger than 70 years of age ( p = 0.005 ) . Conclusion : Cholecystectomy was the preferred treatment after extended long-term follow-up , but conservative management for symptomatic gallstone disease is an alternative to surgery in the elderly BACKGROUND Emergency laparoscopic cholecystectomy has been advocated for the treatment of acute cholecystitis ; however it can be a difficult task , especially in public hospitals , with relatively high conversion and complication rates . Percutaneous cholecystostomy is a simple and effective procedure allowing patients to recover from the acute event and undergo elective laparoscopic surgery at a later stage . METHODS We prospect ively assessed a protocol of initial conservative treatment in patients admitted with acute cholecystitis . Patients who did not respond to medical treatment were treated by percutaneous cholecystostomy .  Following discharge the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary . The details of the operation were collected with emphasis on complications and conversion rate . RESULTS During a 3-year period , 224 patients who were admitted with acute calculous cholecystitis entered the protocol . Fifty-four patients did not improve under medical treatment and percutaneous cholecystostomy was performed . In spite of adequate drainage , 5 patients still did not improve : 3 patients were successfully operated upon urgently and recovered , while 2 patients who had severe concomitant diseases and multi-organ failure , died . Forty-nine patients were discharged with the catheter and later re-evaluated for elective operation . In 7 patients common bile duct stones were found and were removed by ERCP prior to the elective operation . Twenty-five patients underwent delayed laparoscopic cholecystectomy with a low conversion rate ( 8 % ) , and only minor complications ( 16 % ) . CONCLUSIONS Conservative treatment and delayed operation is still an acceptable choice in the treatment of acute cholecystitis . Percutaneous cholecystostomy is an effective tool , with high success rate and low morbidity , and allows for better pre-operative evaluation of the biliary system and safe interval laparoscopic surgery . Laparoscopic cholecystectomy after drainage of the gall bladder is a low morbidity procedure with relatively low conversion rate Introduction Accidental rupture of the gallbladder is an event which occurs in up to 20 % of laparoscopic cholecystectomies , mainly in those where dissection is difficult , or during extraction when the gallbladder is withdrawn directly through the laparoscope port . It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection . It is common practice , therefore , for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs . Objective To compare 2 groups of similar patients , to determine whether administration of antibiotics , started during surgery , is actually useful in reducing the risk of residual abscess or infection in the surgical wound . Patients and Method The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy . This total was divided at r and om into 2 groups : group A ( 80 patients ) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture , followed by 2 more doses at intervals of 8 hours in the immediate postoperative period ; and group B ( 86 patients )  who did not receive any antibiotic treatment at all . The dependent variables observed were surgical wound infection and residual abscess : and the control variables were age , sex , length of operation time , intercurrent illnesses , and American Society of Anesthesiologists ( ASA ) classification . Results Two patients ( 2.5 % ) in group A developed a surgical wound infection , against 3 cases ( 3.4 % ) in group B , the result having no statistical significance . No patients developed residual abscess . In a multivariant analysis , the following were identified as independent factors significantly associated with the onset of surgical wound infection ( P<0.001 ) : diabetes mellitus , being over 60 years of age , operation time lasting longer than 70 minutes , and ASA 3 . Conclusions Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary . In the case of patients with diabetes mellitus , those who are older than 60 , or who have an ASA classification of 3 or more , or if the operation itself is likely to last more than 70 minutes , the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery Abstract . This prospect i ve study determines the indications for and the optimal timing of laparoscopic cholecystectomy ( LC ) following the onset of acute cholecystitis . It also evaluates preoperative and operative factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy in the presence of acute cholecystitis . Having been established as the procedure of choice for elective cholelithiasis , LC is now also used for management of acute cholecystitis . Under these circumstances the procedure may be difficult and challenging . Certain favorable and unfavorable conditions may be present that influence the conversion and complication rates . Information about these conditions may be helpful for elucidating the optimal circumstances for LC or when the procedure is best avoided . We performed LC on an emergency basis as soon as the diagnosis was made on all patients presenting with acute cholecystitis from January 1994 to December 1995 . All preoperative , operative , and postoperative data were collected on st and ardized forms . Of the 137 patients registered , 130 were eligible for the audit . Seven patients found by laparoscopic intraoperative cholangiography to have choledocholithiasis were converted for common bile duct exploration and were excluded from the study . Altogether 93 patients ( 72 % ) underwent successful LC and 37 ( 28 % ) needed conversion to open cholecystectomy . The conversion rate of acute gangrenous cholecystitis ( 49 % ) was significantly higher than that for uncomplicated acute cholecystitis ( 4.5 % ) ( p < 0.00001 ) and for hydrops ( 28.5 % ) and empyema of the gallbladder ( 28.5 % ) ( p= 0.004 ) . The difference in conversion between the group with acute necrotizing ( gangrenous ) cholecystitis and the two groups with hydrops and empyema of the gallbladder was not statistically significant ( p= 0.07 ) . The complication rates of acute cholecystitis , hydrops , empyema of the gallbladder , and gangrenous cholecystitis were 9.0 % , 9.5 % , 14.0 % , and 20.0 % , respectively ( p= NS ) . Patients with an operative delay of 96 hours or less from the onset of acute cholecystitis had a conversion rate of 23 % , whereas a delay of more than 96 hours was associated with a conversion rate of 47 % ( p= 0.022 ) . The complication rate was 8.5 % in the laparoscopic group and 27 % in the converted group ( p= 0.013 ) . Patients over 65 years of age , with a history of biliary disease , a nonpalpable gallbladder , WBC count over 13,000/cc , and acute gangrenous cholecystitis were independently associated with a high LC conversion rate ; male patients , finding large bile stones , serum bilirubin over 0.8 mg/dl , and WBC count over 13,000/cc were independently associated with a high complication rate following laparoscopic surgery with or without conversion . Generally , LC can be performed safely for acute cholecystitis , with acceptably low conversion and complication rates . Different forms of cholecystitis carry various conversion and complication rates in selected cases . LC for acute cholecystitis should be performed within 96 hours of the onset of disease . Predictors of conversion and complications may be helpful when planning the laparoscopic approach to acute cholecystitis Abstract Background . Cholecystectomy is routinely recommended to prevent recurrent disease after an initial episode of acute cholecystitis . Therefore , r and omized controlled trials have mainly focused on the timing of surgery , but many patients scheduled for cholecystectomy have deferred surgery with long periods of symptom-free intervals . Our present aim is to examine the long-term feasibility and safety of observation compared with surgery . Methods . Trial of 64 patients with acute cholecystitis previously r and omized to observation or cholecystectomy  , which examined outcome in terms of completed r and omized treatment and appearance of further symptoms and the need for surgical treatment .  Thirty-three patients were r and omized to observation and 31 patients to cholecystectomy .  Median follow-up was 14 years . Results . Of the 33 patients r and omized to observation , 11 ( 33 % ) experienced a new event of gallstone-related disease ( eight ( 24.2 % ) had acute cholecystitis ) and 11 ( 33 % ) were operated . No significant difference ( p = 0.565 ) was found between the two r and omized groups with regard to recurrent disease or complications . Virtually no surgery took place after 5 years of follow-up . The difference in completed r and omized treatment between the groups was not significant ( p = 0.077 ) . Long-term mortality was equal in those operated and in those observed . Conclusions . Twenty-four percent of the patients experienced recurrent cholecystitis , but escalation of disease severity or increased mortality was not observed . Long-term observation after acute cholecystitis was feasible in two-thirds of the patients as the risk for recurrent disease was negligible after 5 years Some surgeons drain the gallbladder bed routinely , some selectively and some not at all . We aim ed to clarify this confusion by entering 155 consecutive patients undergoing emergency and elective cholecystectomy without exploration of the common bile duct into a r and om control clinical trial . In 78 patients a 3 mm suction drain was left in the gallbladder bed and in 77 the abdomen was closed without drainage . There were no withdrawals , one death ( in the drainage group ) from myocardial infa rct ion and one intraperitoneal abscess complicating postoperative pancreatitis ( in the no‐drainage group ) . Other events studied were postoperative pyrexia , wound infection , respiratory tract infection and duration of hospital stay . In none of these did the two groups differ either clinical ly or statistically . We conclude that drainage or non‐drainage of the gallbladder bed must remain a matter of individual preference Background In the absence of r and omized controlled trials with sufficient power to assess the effectiveness of prophylactic antibiotics ( PA ) , the best evidence is provided by large population -based register studies . Methods The Swedish Register of Gallstone Surgery and ERCP ( GallRiks ) started in May 2005 and reached 75 % national coverage in 2007 . During 2006 and 2007 , a total of 16,400 operations were registered in GallRiks . In the present study , all elective procedures performed in 2006–2007 in units performing at least 25 operations annually were included in an analysis of the risk for postoperative infectious complications Results Altogether 10,927 procedures were performed 2006–2007 .  Univariate logistic regression analysis revealed a paradoxical increase in postoperative infectious complications requiring antibiotic treatment and postoperative abscess if PA were given ( p < 0.05 ) . This increase disappeared in multivariate analysis with adjustment for age , gender , presence of cholecystitis , accidental gallbladder perforation , and presence of bile duct stones . Conclusion No benefit from PA was seen in this study on elective cholecystectomy . Although a r and omized controlled trial could possibly show a reduction in the risk for postoperative infectious complications not detected in this study , such a reduction must be weighed against the risk of promoting drug resistance by the widespread use of PA BACKGROUND / AIMS The aim of this study was to evaluate the effect of antibiotic prophylaxis on the development of infectious complications in laparoscopic cholecystectomy . METHODOLOGY A total of 208 patients undergoing elective laparoscopic cholecystectomy were r and omized , double-blinded into one of two treatment arms : 1 ) cefazolin 1 g intravenously after induction of anesthesia and 2 ) no prophylactic antibiotics . The patients were followed-up for infectious complications for 30 days at the out-patient clinic . The data collected included age , sex , body mass index , ultrasonography findings , accompanying diseases , perforation during surgery , stone spillage , operation time , port of gallbladder delivery , suture material used for skin closure , preoperative and length of postoperative hospitalization , bile culture , pathology of the gallbladder , serum biochemical findings including alanine aminotransferase , aspartate aminotransferase , gammaglutamyl transpeptidase , bilirubin , alkaline phosphatase and glucose . RESULTS Overall rate of infection was 3.36 % . Four out of 105 patients who received antibiotics and 3 out of 103 patients who did not receive antibiotics developed infection . The difference was not statistically significant . Obesity and closing the skin with nylon sutures were found to be associated with increased rate of infectious complications . CONCLUSIONS Cefazolin prophylaxis in low risk patients has no effect on postoperative infection rate in laparoscopic cholecystectomy BACKGROUND Patients who undergo endoscopic sphincterotomy for common bile-duct stones , who have residual gallbladder stones , are referred for  laparoscopic cholecystectomy .  However , only 10 % of patients who do not have this operation are reported to develop recurrent biliary symptoms . We aim ed to assess whether a wait- and -see policy is justified . METHODS We did a prospect i ve , r and omised , multicentre trial in 120 patients ( age 18 - 80 years ) who underwent endoscopic sphincterotomy and stone extraction , with proven gallbladder stones . Patients were r and omly allocated to wait and see ( n=64 ) or laparoscopic cholecystectomy ( 56 ) . Primary outcome was recurrence of at least one biliary event during 2-year follow-up , and secondary outcomes were complications of cholecystectomy and quality of life . Analysis was by intention to treat . FINDINGS 12 patients were lost to follow-up immediately . Of 59 patients allocated to wait and see , 27 ( 47 % ) had recurrent biliary symptoms compared with one ( 2 % ) of 49 patients after laparoscopic cholecystectomy ( relative risk 22.42 , 95 % CI 3.16 - 159.14 , p<0.0001 ) . 22 ( 81 % ) of 27 patients underwent cholecystectomy , mainly for biliary pain ( n=13 ) or acute cholecystitis ( 7 ) . Conversion rate to open surgery was 55 % in patients allocated to wait and see who underwent cholecystectomy compared with 23 % in those who were allocated laparoscopic cholecystectomy ( p=0.0104 ) . Morbidity was 32 % versus 14 % ( p=0.1048 ) , and median hospital stay was 9 versus 7 days . Quality of life returned to normal within 3 months after either treatment policy . INTERPRETATION A wait- and -see policy after endoscopic sphincterotomy in combined cholecystodocholithiasis can not be recommended as st and ard treatment , since 47 % of expectantly managed patients developed at least one recurrent biliary event and 37 % needed cholecystectomy . No major biliary complications arose , but conversion rate was high BACKGROUND Few studies have been done on the expectant management of patients with cholelithiasis diagnosed by planned investigation , and results are conflicting . METHODS A prospect i ve 6-year follow-up study of 153 patients with cholelithiasis diagnosed by oral cholecystography  was carried out . RESULTS An acute gallstone complication occurred during the follow-up period in 23 patients (15%)-that is , acute cholecystitis ( n = 18 ) , acute pancreatitis ( n = 2 ) , and jaundice ( n = 3 ) . The annual risk of developing an acute biliary complication was 3.1 % . A history of a gallstone complication predicted further gallstone complications during follow-up . The overall cholecystectomy rate was 20 % during the 1st year but fell to about 3 % during the 5th year of follow-up . Young age and frequent attacks of biliary pain episodes predicted the need for gallstone surgery . CONCLUSIONS Expectant management of patients with electively diagnosed cholelithiasis may be justified , especially in those with only occasional biliary symptoms and no history of gallstone complications BACKGROUND Current treatment options for acute calculous cholecystitis include either early cholecystectomy , or conservative treatment consisting of intravenous antibiotics and an interval cholecystectomy several weeks later . Percutaneous drainage is reserved for patients in whom conservative therapy failed or as a salvage procedure for high risk patients . OBJECTIVE To identify clinical and radiographic factors leading to failure of conservative treatment . METHODS We prospect ively collected data on consecutive patients admitted with the diagnosis of acute cholecystitis . Parameters were compared between patients who were successfully treated conservatively and those who required percutaneous cholecystostomy . Logistic regression analysis was performed to identify predictors for failure of conservative treatment . RESULTS The study population comprised 103 patients with a median age of 60 who were treated for acute cholecystitis . Twenty-seven patients ( 26.2 % ) required PC . On univariate analysis , age above 70 years , diabetes , elevated white blood cell count , tachycardia ( > 100 beats/min ) at admission , and a distended gallbladder ( > 5 cm transverse diameter ) were found to be significantly more common in the PC group ( P < 0.001 ) . WBC was higher in the PC group throughout the initial 48 hours . On multivariate analysis , age above 70 ( odds ratio 3.6 ) , diabetes ( OR 9.4 ) , tachycardia at admission ( OR 5.6 ) , and a distended gallbladder ( OR 8.5 ) were predictors for cholecystostomy ( P < 0.001 ) . Age above 70 ( OR 5.2 ) and WBC $ 15,000 ( OR 13.7 ) were predictors for failure of conservative treatment after 24 and 48 hours ( P < 0.001 ) . CONCLUSIONS Age above 70 , diabetes , and a distended gallbladder are predictors for failure of conservative treatment and such patients should be considered for early cholecystostomy . Persistently elevated WBC ( > 15,000 ) suggests refractory disease and should play a central role in the clinical follow-up and decision-making process for elderly patients with acute cholecystitis
Discussion Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe , especially in patients with mild disease .
Background In medical practice , the tendency to remove an inflamed gallbladder is deeply rooted .
Cholecystectomy , however , is associated with relatively high complication rates , and therefore the decision whether or not to perform surgery should be well considered .
For some patients , the surgical risk – benefit profile may favour conservative treatment .
The objective of this study was to examine the short- and long-term outcome of conservative treatment of patients with acute calculous cholecystitis .