What is the treatment for gallbladder attacks?

Treatment of Gallbladder Attacks

Early laparoscopic cholecystectomy is the first-choice treatment for gallbladder attacks (acute cholecystitis) and generally results in shorter recovery time and hospitalization compared to delayed cholecystectomies. 1, 2

Initial Management of Acute Gallbladder Attacks

Immediate Interventions

• Pain control: NSAIDs may be the treatment of choice for acute pain attacks 3
• NPO status: Nothing by mouth until surgical evaluation
• IV fluids: For hydration and electrolyte management
• Antibiotic therapy:
  • For uncomplicated cases: One-shot antibiotic prophylaxis if early intervention is planned 2
  • For complicated cholecystitis: 4 days of antibiotics in immunocompetent patients, up to 7 days in immunocompromised or critically ill patients 2, 4

Definitive Treatment

Surgical Management

• Early laparoscopic cholecystectomy (within 7-10 days of symptom onset) is the gold standard treatment 1, 2
  • Benefits include shorter hospital stay, fewer complications, and lower costs 2
  • Should be performed within 7 days of hospital admission and within 10 days of symptom onset 2
  • Recommended during all trimesters of pregnancy 2

Alternative Management Options

• Delayed laparoscopic cholecystectomy (after 6 weeks) if early surgery is not possible 2

• Percutaneous cholecystostomy (gallbladder drainage) for patients who:

  • Are not suitable for surgery due to critical illness 1
  • Have multiple comorbidities 1
  • Are septic due to gallbladder empyema 1
  • This converts a septic patient with acute cholecystitis into a non-septic patient 1

• Subtotal cholecystectomy may be considered in difficult cases with obscured anatomy to avoid biliovascular injuries 5

Special Considerations

Factors Affecting Surgical Approach

• Conversion risk factors from laparoscopic to open cholecystectomy 6:
  • Age >60 years
  • Male sex
  • Duration of complaint >24 hours
  • Gangrenous cholecystitis (40% conversion rate vs. 8% for uncomplicated cases)
  • Leukocyte count >15,000/cc³

Complication Risk Factors

• Duration of complaint >48 hours
• Male sex, age >60 years
• Associated diseases
• Larger bile stones
• Elevated serum bilirubin levels 6

Follow-up Care

• Most patients can be discharged within 1-2 days after laparoscopic cholecystectomy 2
• Follow-up at 7-10 days for:
  • Wound evaluation
  • Monitoring for resolution of symptoms
  • Signs of infection 2

Pitfalls and Caveats

• Dyspeptic symptoms (indigestion, belching, bloating) are common in persons with gallstones but may be unrelated to the stones themselves and frequently persist after surgery 3
• Persistent dyspeptic symptoms occur frequently following cholecystectomy, especially in patients with a prolonged history of such symptoms prior to surgery 3
• Antibiotics should not be continued beyond 7 days unless there are ongoing signs of infection 2, 4
• Prophylactic cholecystectomy is generally not recommended for asymptomatic gallstones 7

Early intervention with laparoscopic cholecystectomy remains the cornerstone of treatment for gallbladder attacks, with gallbladder drainage reserved for those who cannot tolerate surgery. The evidence strongly supports early surgical intervention to reduce complications and improve outcomes.