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Abdominal SepsisAcute Cholecystitis

Abdominal Sepsis: Acute Cholecystitis [Although acute cholecystitis is a common disease, until 2007 there were no definite and clear diagnostic criteria and treatment guidelines about it. In 2007 and 2013, the Tokyo guidelines for acute calculous cholecystitis were drafted and updated. In 2013 and 2016, the World Society of Emergency Surgery (WSES) developed and updated its guidelines in order to clarify some important topics. According to WSES guidelines, early laparoscopic cholecystectomy is the best therapeutic approach for acute calculous cholecystitis and postoperative antibiotics are not necessary in case of uncomplicated cholecystitis. Moreover, regarding indications for the management of associated common bile duct stones, according to the American Society for Gastrointestinal Endoscopy guidelines, patients with an high risk of common bile duct stones should have a preoperative endoscopic retrograde cholangiopancreatography; patients with a moderate risk should have noninvasive preoperative investigation. The WSES guidelines emphasized the importance of patient surgical risk assessment and the indications for surgical treatment of acute calculous cholecystitis were limited to patients who may be fit for urgent surgery. However, there are poor data about criteria to define high-risk patient. According to some high-quality studies, subtotal cholecystectomy and a low threshold for conversion should be recommended in cases of severe acute inflammation of the gallbladder at intervention. For acalculous acute cholecystitis, the best treatment depends on patient’s conditions. In critically ill patients, percutaneous cholecystostomy has been found to be the best treatment in terms of mortality, morbidity, and costs.] http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

Abdominal SepsisAcute Cholecystitis

Part of the Hot Topics in Acute Care Surgery and Trauma Book Series
Editors: Sartelli, Massimo; Bassetti, Matteo; Martin-Loeches, Ignacio
Fugazzola, Paola; Coccolini, Federico; Montori, Giulia; Merli, Cecilia; Pisano, Michele; Ansaloni, Luca
Abdominal Sepsis — Jun 23, 2017
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Publisher
Springer International Publishing
Copyright
© Springer International Publishing AG, part of Springer Nature 2018
ISBN
978-3-319-59703-4
Pages
51 –64
DOI
10.1007/978-3-319-59704-1_6
Publisher site
See Chapter on Publisher Site

Abstract

[Although acute cholecystitis is a common disease, until 2007 there were no definite and clear diagnostic criteria and treatment guidelines about it. In 2007 and 2013, the Tokyo guidelines for acute calculous cholecystitis were drafted and updated. In 2013 and 2016, the World Society of Emergency Surgery (WSES) developed and updated its guidelines in order to clarify some important topics. According to WSES guidelines, early laparoscopic cholecystectomy is the best therapeutic approach for acute calculous cholecystitis and postoperative antibiotics are not necessary in case of uncomplicated cholecystitis. Moreover, regarding indications for the management of associated common bile duct stones, according to the American Society for Gastrointestinal Endoscopy guidelines, patients with an high risk of common bile duct stones should have a preoperative endoscopic retrograde cholangiopancreatography; patients with a moderate risk should have noninvasive preoperative investigation. The WSES guidelines emphasized the importance of patient surgical risk assessment and the indications for surgical treatment of acute calculous cholecystitis were limited to patients who may be fit for urgent surgery. However, there are poor data about criteria to define high-risk patient. According to some high-quality studies, subtotal cholecystectomy and a low threshold for conversion should be recommended in cases of severe acute inflammation of the gallbladder at intervention. For acalculous acute cholecystitis, the best treatment depends on patient’s conditions. In critically ill patients, percutaneous cholecystostomy has been found to be the best treatment in terms of mortality, morbidity, and costs.]

Published: Jun 23, 2017

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