Our Summary

This research paper is an update to the 2016 guidelines of the World Society of Emergency Surgery (WSES) on the treatment of Acute Calculus Cholecystitis (ACC), a common gallbladder disease. A team was formed to review new scientific evidence and revise the guidelines.

One of the main updates is the confirmation of surgery’s crucial role in treating ACC, even for patients who are considered high-risk because of age or other health conditions. Techniques like Early Laparoscopic Cholecystectomy (ELC), a minimally invasive surgical procedure, are the recommended standard care wherever possible.

The revised guidelines also note that the role of gallbladder drainage has reduced, despite technical advancements. They also suggest that Subtotal Cholecystectomy, a procedure where part of the gallbladder is removed, is a safe and valuable option when full removal is challenging.

The paper ends by highlighting the need for more research on the role of clinical judgment and scoring tools in treatment decisions for high-risk patients or those unsuitable for surgery. It also recommends the development of local policies for safe laparoscopic cholecystectomy.

FAQs

  1. What are the updated guidelines from the World Society of Emergency Surgery (WSES) for treating Acute Calculus Cholecystitis (ACC)?
  2. What surgical procedures are recommended for high-risk patients with ACC according to the revised guidelines?
  3. What is the significance of gallbladder drainage in the updated guidelines for ACC treatment?

Doctor’s Tip

One helpful tip a doctor might give a patient about cholecystectomy is to follow their post-operative care instructions carefully. This may include recommendations on diet, activity level, pain management, and follow-up appointments. Adhering to these instructions can help improve recovery and prevent complications.

Suitable For

Patients typically recommended cholecystectomy include those with acute calculus cholecystitis (ACC), especially those who are considered high-risk due to age or other health conditions. Early Laparoscopic Cholecystectomy (ELC) is the preferred technique for surgery, even for high-risk patients. Subtotal cholecystectomy may be considered for patients in whom full removal of the gallbladder is challenging. More research is needed on the role of clinical judgment and scoring tools in treatment decisions for high-risk patients, as well as the development of local policies for safe laparoscopic cholecystectomy.

Timeline

Before cholecystectomy:

  1. Patient experiences symptoms of ACC such as abdominal pain, fever, nausea, and vomiting.
  2. Patient undergoes diagnostic tests like ultrasound or CT scan to confirm the diagnosis of ACC.
  3. Patient may receive conservative treatment like antibiotics and pain management to alleviate symptoms.

After cholecystectomy:

  1. Patient undergoes surgery, either laparoscopic or open, to remove the gallbladder.
  2. Patient may experience some pain and discomfort post-surgery, which can be managed with pain medication.
  3. Patient is typically discharged from the hospital within a few days after surgery.
  4. Patient is advised to follow a special diet and avoid fatty foods to aid in digestion without a gallbladder.
  5. Patient may experience some digestive issues like diarrhea or bloating in the initial weeks after surgery, which usually improves over time.
  6. Patient may need to follow up with their surgeon for post-operative care and monitoring.

What to Ask Your Doctor

  1. What are the benefits of Early Laparoscopic Cholecystectomy (ELC) compared to other surgical techniques for treating Acute Calculus Cholecystitis (ACC)?

  2. Are there any specific risk factors or health conditions that would make me a high-risk patient for cholecystectomy? How would surgery be approached in my case?

  3. Can you explain the potential complications or side effects of undergoing a cholecystectomy procedure?

  4. What is the recovery process like after cholecystectomy surgery? How long can I expect to be in the hospital and how soon can I resume normal activities?

  5. Are there any alternative treatments or procedures to cholecystectomy that I should consider or be aware of?

  6. How often do complications arise from cholecystectomy surgery, and what measures are in place to manage or prevent them?

  7. What is your experience with performing cholecystectomy surgeries, and what is the success rate for patients like me?

  8. Are there any specific pre-operative or post-operative instructions I should follow to ensure the best possible outcome from the surgery?

  9. How will my quality of life be affected after undergoing cholecystectomy surgery, and are there any long-term implications I should be aware of?

  10. Can you provide me with information on local policies or resources for safe laparoscopic cholecystectomy in case I need further assistance or care after the surgery?

Reference

Authors: Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, Coccolini F, Tufo A, Di Martino M, Leung J, Sartelli M, Ceresoli M, Maier RV, Poiasina E, De Angelis N, Magnone S, Fugazzola P, Paolillo C, Coimbra R, Di Saverio S, De Simone B, Weber DG, Sakakushev BE, Lucianetti A, Kirkpatrick AW, Fraga GP, Wani I, Biffl WL, Chiara O, Abu-Zidan F, Moore EE, Leppäniemi A, Kluger Y, Catena F, Ansaloni L. Journal: World J Emerg Surg. 2020 Nov 5;15(1):61. doi: 10.1186/s13017-020-00336-x. PMID: 33153472