2016 WSES guidelines on acute calculous cholecystitis.

Luca Ansaloni ,Frederick A Moore ,Michael Sugrue ,Ferdinando Agresta ,Michele Pisano ,Osvaldo Chiara ,Korhan Taviloğlu ,Rao R Ivatury ,Philip F Stahel ,Ian Bailey ,Iftikhar H Wani ,G Camapanelli ,Walter L Biffl ,Massimo Sartelli ,Cino Bendinelli ,Gregorio Tugnoli ,Boris Sakakushev ,Giuseppe Borzellino ,Sanjay Gupta ,Jeffry L Kashuk ,Mark De Moya ,Raúl Coimbra ,Gustavo Pereira Fraga ,Ronald V Maier ,Marco Ceresoli ,Andrew Peitzmann ,Venkata Koka ,Pierluigi Viale ,George C Velmahos ,Kurinchi Selvan Gurusamy ,Rifat Latifi ,Francesco Brunetti ,Hans Jeekel ,S Uraneus ,Luigi Bonavina ,Abe Fingerhut ,Ian Civil ,Dieter Weber ,Fabio Cesare Campanile ,Yoram Kluger ,Clay Cothren Burlew ,Dario Piazzalunga ,Zsolt J Balogh ,Fausto Catena ,A Allegri ,Salomone Di Saverio ,Thomas M Scalea ,Ingo Marzi ,Ari Leppäniemi ,Michael D Kelly ,Ernest E Moore

doi:10.1186/s13017-016-0082-5

Abstract

Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of “high risk” patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.

Highlights

Gallstones are common and present as acute calculus cholecystitis (ACC) in 20 % of patients with symptomatic disease, with wide variation in severity
Twelve variables related to history and clinical examination, 5 variables related to basic laboratory tests, and one variable which was a combination of a clinical sign and a laboratory test were tested in a cohort of patients with abdominal pain or suspected acute cholecystitis
Both ACC and acute acalculous cholecystitis had been included as target condition in this review; the results may have been different if ACC alone had been included as the target condition

Summary

Introduction

Gallstones are common and present as acute calculus cholecystitis (ACC) in 20 % of patients with symptomatic disease, with wide variation in severity. Statement 4.2 The co-existence of diabetes mellitus does not contraindicate urgent surgery but must be re-considered as a part of the overall patient comorbidity (LoE 3 GoR C) In 1995, Shpitz et al showed a greater incidence of cardiovascular disease and associated bacterobilia in diabetics who underwent urgent cholecystectomy for ACC; they did not report a significant difference in the postoperative outcome [68].

Results

Conclusion