Abstract

ANGEL-GONZALEZ, Manuel Santiago et al. Controversies in the management of late acute cholecystitis. rev. colomb. cir. [online]. 2019, vol.34, n.4, pp.364-371. ISSN 2011-7582.  https://doi.org/10.30944/20117582.516.

Acute cholecystitis is the inflammation of the gallbladder, in most cases explained by the presence of mixed or cholesterol stones that produce obstruction by triggering various inflammatory factors; for its definitive management, laparoscopic cholecystectomy became the gold standard, the surgical procedure should ideally be performed within the first 72 hours after the onset of symptoms, which is usually referred to as acute condition; There are controversies in what is the most appropriate management when more than 72 hours have elapsed from the onset of symptoms, a condition called late acute cholecystitis, at which time the inflammatory process is commonly believed to be greater and the procedure more technically complex and dangerous.

For this condition, two management strategies have been defined, which consist of early surgery (during index hospitalization) versus initial conservative antibiotic treatment for the supposed complete resolution of the inflammation “cooling the process”, followed by a late laparoscopic cholecystectomy several weeks later (deferred, elective); For both strategies, there is abundant literature exposing the benefits and probable complications that concern each one, but at the present time the optimal moment to practice the surgical intervention is still being debated. The most recent works show some benefits in favor of early surgery, since although intraoperative complications occur in the same proportions, surgery in the index hospitalization reduces costs, readmissions, and hospital times. The present article, reviewing the wide literature available for and against, has as main objective to recommend this procedure early, even when more than three days of symptoms have passed, and only in very selected cases, defer surgery.

Keywords : cholecystitis, acute; cholecystectomy, laparoscopic; cholecystostomy; early medical intervention; drug therapy.

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