Treatment for Acute Cholecystitis

Abstract

In this article we summarized treatment for acute cholecystitis focusing on the revision of Tokyo Guidelines 2018 (TG18). The flowchart for the management of acute cholecystitis was revised based not only on the severity grading but also the surgical risk. It is recommended that the Charlson co-morbidity index (CCI) and American Society of Anesthesiologists physical status classification (ASA-PS) be used to assess a patient's surgical risk. Early laparoscopic cholecystectomy (LC) should ideally be performed for patients with mild and moderate cholecystitis patients with low surgical risk. For severe cholecystitis patients with low surgical risk and favorable organ system failure (cardiovascular or renal organ system failure which is rapidly reversible after admission), urgent or early LC can be performed by a specialist surgeon with extensive experience in a setting that allows for intensive care management. For patients with high surgical risk, elective cholecystectomy should be considered after the improvement of the acute inflammatory process. If a patient does not respond to the initial medical treatment, urgent or early gallbladder drainage is required.