What is the role of surgery in the treatment of acalculous cholecystitis?

Updated: Feb 14, 2019
  • Author: Homayoun Shojamanesh, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

In surgical candidates, open or laparoscopic cholecystectomy is indicated for acute cholecystitis. [1, 16] Laparoscopic cholecystectomy performed within 24 hours of inpatient admission has been reported to be safe and is recommended as the preferred treatment option for those with American Society of Anesthesiologists (ASA) grade I-III disease. [17]

In patients who are not surgical candidates, percutaneous cholecystostomy may be performed in the radiology suite. This procedure may the safest and most successful intervention in patients who are critically ill, have multiple comorbidities, have a high risk for conversion, or who are poor surgical candidates. [1] Catheters are usually removed after approximately three weeks in critically ill patients with acalculous cholecystitis who have undergone percutaneous cholecystostomy. This allows for the development of a mature track from the skin to the gallbladder.

In an observational study (2002-2012) of 56 patients treated with percutaneous cholecystostomy for acute acalculous cholecystitis, Kirkegard et al found the procedure could be used as a definitive treatment option in 45 patients (80.4%) and as a bridge to elective laparoscopic cholecystectomy in 4 patients (7.1%) within a median of 8.8 months. [14] Six patients (10.7%) died within the 30-day postprocedure period.

Anderson et al reported that cholecystostomy offered no survival benefit for patients with severe sepsis and shock; however, cholecystostomy was associated with improved survival compared with patients without surgical management. [18]


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