From the Research
Patients with acute cholecystitis should be kept NPO immediately upon diagnosis to prevent further gallbladder stimulation and inflammation, as this restriction helps reduce pain and prevents additional bile production that could worsen the condition, as supported by the most recent and highest quality study 1. The management of acute cholecystitis involves a comprehensive approach, including medical management and potential surgical intervention.
- The medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics, as stated in the study 2.
- The optimal timeframe to perform early laparoscopic cholecystectomy (ELC) is within 72 h from diagnosis, with a possible extension of up to 7-10 days from symptom onset, as recommended in the study 2.
- Maintaining NPO status is crucial for patients who may require emergency cholecystectomy, as surgery under general anesthesia requires an empty stomach to prevent aspiration risks.
- During this NPO period, patients should receive appropriate IV fluids (typically normal saline or lactated Ringer's solution) to maintain hydration and electrolyte balance, and pain management with IV analgesics such as morphine or hydromorphone and antibiotic therapy (often with piperacillin-tazobactam, ceftriaxone plus metronidazole, or ciprofloxacin plus metronidazole) should be administered while the patient remains NPO, as suggested in the study 3.
- The NPO status is typically maintained until definitive treatment is determined, whether that involves early laparoscopic cholecystectomy or conservative management with delayed surgery, as indicated in the study 1.
- It is essential to note that the definition of high-risk patients is crucial in interpreting the results, and the methods of assessment and definitions differ between studies, as mentioned in the study 4.
- The Tokyo Guidelines 2018 (TG18) expand the indications for laparoscopic cholecystectomy (LC) under difficult conditions for each level of severity of acute cholecystitis, and propose standardized safe steps for LC to treat acute cholecystitis, as stated in the study 5.