Acute cholecystitis managed in a rural surgical department

Objectives
This study aims to define the outcome over a prolonged
period of an unselected cohort of patients presenting with
acute cholecystitis (AC) to a 560 bed rural hospital in Israel.
Design, setting and participants
Retrospective case series analysed from a single referral
centre between 2006 and 2015. Separated into Group 1
managed by emergent cholecystectomy, Group 2 treated
with antibiotics and delayed cholecystectomy, Group 3
treated with percutaneous cholecystostomy (PC) and
selected delayed cholecystectomy and Group 4 managed
entirely conservatively with no subsequent
cholecystectomy.
Methods
Assessment of complication rates: in-hospital and delayed
cause-specific morbidity and mortality along with
conversion rates and the risk of intraoperative stone
spillage.
Results
Of 321 patients hospitalized for AC, there were 50 in Group
1, 68 in Group 2, 59 in Group 3 and 98 in Group 4. Group 3
were older with more comorbidities and when coming to
surgery had more open conversions. Intraoperative stone
spillage was more common in Groups 2 and 3. The length of
hospital stay was greater for Groups 1 and 3. Of the Group 4
cases, 63.2 per cent remained asymptomatic over a median
follow-up of 78 months. Of those with recurrent biliary
symptoms, 58.3 per cent were ASA Grade III/IV with 25/36
late deaths 80 per cent of which were from non-biliary
causes.
Conclusion
In the management of AC, early cholecystectomy is
favoured with non-operative approaches like PC drainage or
antibiotic treatment alone being reserved for frailer
comorbid cases. The absolute need for subsequent
cholecystectomy is not supported by this series and requires
further investigation.