From the Guidelines
The treatment for cholecystitis typically involves hospitalization, antibiotics, pain management, and often surgical removal of the gallbladder, with laparoscopic cholecystectomy being the preferred definitive treatment, ideally performed within 24-72 hours of diagnosis for acute cases 1.
Initial Management
Initial management includes:
- Intravenous fluids
- Nothing by mouth (NPO status)
- Pain control with medications like morphine or hydromorphone
- Antibiotic therapy should be started promptly, typically with regimens such as piperacillin-tazobactam 3.375g IV every 6 hours, or a combination of ceftriaxone 1-2g IV daily plus metronidazole 500mg IV every 8 hours, generally for 4-7 days
Definitive Treatment
Definitive treatment is usually laparoscopic cholecystectomy, which is preferred over open cholecystectomy due to its lower risk of complications and shorter hospital stay 1.
- In patients who are poor surgical candidates, percutaneous cholecystostomy (gallbladder drainage) may be performed as a temporizing measure
- For mild cases caused by gallstones, conservative management with antibiotics and eventual elective cholecystectomy may be appropriate
Special Considerations
- Early surgical intervention is preferred because it reduces overall hospital stay and decreases the risk of complications such as gallbladder perforation, abscess formation, or progression to sepsis
- Following cholecystectomy, most patients can resume normal diet and activities within 1-2 weeks
- Cholecystostomy may be an option for acute cholecystitis in patients with multiple comorbidities and unfit for surgery patients who do not show clinical improvement after antibiotic therapy for days 1
From the Research
Treatment for Cholecystitis
The treatment for cholecystitis typically involves a combination of medical and surgical interventions.
- Cholecystectomy, which is the surgical removal of the gallbladder, is often recommended for patients with acute cholecystitis 2, 3, 4, 5.
- The timing of cholecystectomy is crucial, with early laparoscopic cholecystectomy preferred over delayed surgery due to better quality of life, lower morbidity rates, and lower hospital costs 4, 5.
- However, a study found that delayed surgical intervention may be harmless and even superior to immediate treatment for acute cholecystitis 6.
- Antibiotic use is also an important consideration, with guidelines recommending against routine use of peri-operative antibiotic agents in low-risk patients undergoing elective laparoscopic cholecystectomy, but recommending their use in patients undergoing laparoscopic cholecystectomy for acute cholecystitis 2.
- The optimal approach to support early cholecystectomy is suggested, but requires evidence from further randomized trials 5.
Surgical Management
- Laparoscopic cholecystectomy is the preferred surgical method for treating acute cholecystitis, with a low risk of complications and mortality 3, 4, 5.
- The value of additional treatments, such as intraoperative cholangiography and management of common bile duct stones, is still a matter of debate and should be based on institutional expertise and resource availability 5.
- Robotic surgery, single-incision laparoscopic cholecystectomy, and natural orifice transluminal endoscopic surgery (NOTES) are not routinely recommended for the treatment of acute cholecystitis due to lack of evidence 5.
Patient Considerations
- Patient's clinical status and available resources in their particular hospital should be taken into account when making management decisions for acute cholecystitis 4.
- Elderly and high-risk patients may benefit from cholecystectomy, which is more effective and has lower mortality than percutaneous cholecystostomy 5.