According to the current S3 guideline, in acute cholecystitis (gallbladder inflammation), laparoscopic cholecystectomy should be performed early, i.e., within 24 hours of hospital admission, to prevent complications. See also under “Further notes”.
1st order
- Cholecystectomy (CHE; CCE; removal of the gallbladder) – can be either.
- Open-surgically via laparotomy (abdominal incision; open CCE or
- performed laparoscopically (by laparoscopy) [= laparoscopic cholecystectomy; therapy of choice.
- (classic) laparoscopic CCE
- Single-port CCE (all work through one central access) [standard].
- Natural-orifice-transluminal-endoscopic-surgery(NOTES)-CCE/Operative technique in which the patient is operated on through approaches selected through natural orifices]
- ERCP (endoscopic retrograde cholangiopancreaticography) with endoscopic stone removal.
Further notes
- The German ACDC study provides convincing arguments for laparoscopic cholecystectomy for acute cholecystitis within 24 hours.
- According to a British registry analysis, evidence suggests that about half of patients with acute cholecystitis can do without surgery and that in the remainder, interval surgery is not detrimental: While 1-year mortality from all causes was higher in the nonoperated group compared with the operated group (12.2% vs. 2.0%, P <0.001), gallbladder-related deaths were significantly lower than all other causes of death in the nonoperated group ( 3.3% vs. 8.9%, P <0.001). After matching, the total hospitalization time of 1 year after emergency was significantly longer than after interval cholecystectomy (17.7 d vs 13 d, P <0.001).
- Laparoscopic cholecystectomy is still safe four to seven days after the onset of acute cholecystitis. Only the blood loss is greater than in a previous operation (140 versus 69 ml).
