Our Summary

This research paper discusses the best treatment for patients with sudden and severe gallbladder inflammation, specifically those with gallstones. The paper suggests that the best treatment is an early surgical removal of the gallbladder using a laparoscope, a small tube with a camera. This is recommended even for high-risk patients. Ideally, the surgery should be performed within 72 hours of the first symptoms appearing, and definitely within 7-10 days. If surgery is not an option, a procedure to drain the gallbladder may be considered. The experience of the medical team and the technology available at the unit are important factors in deciding the right procedure.

FAQs

  1. What is the first choice of treatment for patients with acute calculous cholecystitis?
  2. What is the ideal timing for a laparoscopic cholecystectomy after the onset of symptoms?
  3. What alternatives are available if surgery is contraindicated for patients with acute cholecystitis?

Doctor’s Tip

A doctor may advise a patient undergoing cholecystectomy to follow a low-fat diet post-surgery to prevent discomfort and aid in digestion. They may also recommend gradually increasing physical activity to promote healing and prevent complications. It is important for the patient to follow all post-operative instructions provided by their healthcare team to ensure a successful recovery.

Suitable For

Patients who are typically recommended cholecystectomy include those with:

  1. Acute calculous cholecystitis: Surgery is often recommended within 72 hours of the onset of symptoms, with a duration of symptoms not exceeding 7-10 days.
  2. High risk patients: Even in high risk patients, early laparoscopic cholecystectomy is considered the first choice.
  3. Patients who are unable to undergo surgery: In cases where surgery is contraindicated, percutaneous or endoscopic gallbladder drainage may be considered as an alternative.
  4. Patients with recurrent episodes of cholecystitis: Cholecystectomy may be recommended for patients who have had multiple episodes of cholecystitis.
  5. Patients with complications of cholecystitis: Cholecystectomy may be recommended for patients who develop complications such as gallbladder perforation, abscess formation, or pancreatitis.

Timeline

Before cholecystectomy:

  • Patient presents with symptoms such as abdominal pain, nausea, vomiting, and fever
  • Patient undergoes physical examination, blood tests, and imaging studies (ultrasound, CT scan) to diagnose acute cholecystitis
  • If diagnosed, patient may be admitted to the hospital for observation and conservative management (antibiotics, pain medication, fasting)
  • Surgeon assesses patient’s condition and determines if laparoscopic cholecystectomy is appropriate
  • Surgery is scheduled within 72 hours of symptom onset if possible

After cholecystectomy:

  • Patient undergoes laparoscopic cholecystectomy procedure to remove the gallbladder
  • Patient may experience mild pain and discomfort post-surgery, which is managed with pain medication
  • Patient is discharged from the hospital within a few days and instructed on post-operative care (diet, activity restrictions)
  • Patient follows up with surgeon for post-operative evaluation and monitoring
  • Patient gradually resumes normal activities and diet, and usually experiences relief from symptoms related to gallbladder issues

What to Ask Your Doctor

  1. What are the potential risks and complications of a cholecystectomy procedure?
  2. How long is the recovery period after a cholecystectomy?
  3. Will I need to make any dietary or lifestyle changes after the procedure?
  4. Are there any alternative treatments or procedures available for my condition?
  5. What is the success rate of a cholecystectomy in treating my condition?
  6. How experienced is the surgical team in performing cholecystectomy procedures?
  7. What type of anesthesia will be used during the procedure?
  8. Will I need to stay in the hospital after the procedure, and if so, for how long?
  9. How soon after the procedure can I return to normal activities?
  10. What follow-up care will be needed after the cholecystectomy?

Reference

Authors: Martínek L, Hoch J. Journal: Rozhl Chir. 2024;103(8):294-298. doi: 10.48095/ccrvch2024294. PMID: 39313357