Which Specialist Manages Gallbladder Disease
General surgeons are the primary specialists who manage gallbladder disease, including acute calculous cholecystitis, with surgical treatment being the definitive standard of care. 1
Primary Specialist: General Surgery
General surgeons perform laparoscopic cholecystectomy, which is the gold standard treatment for acute calculous cholecystitis and should be performed early (within 24-48 hours to 7-10 days of symptom onset) whenever possible 1, 2
Surgery is the pivotal treatment even in high-risk patients, including the elderly, those with cardiac disease, renal disease, cirrhosis, or those generally considered high-risk for surgery 1
The World Society of Emergency Surgery emphasizes that general surgeons should manage these cases, as early laparoscopic cholecystectomy results in significantly fewer complications, better healthcare resource utilization, shorter hospital stays, and lower costs compared to delayed or non-operative approaches 2
Multidisciplinary Support Team
While general surgeons are the primary specialists, complex cases may require:
Interventional radiologists for percutaneous transhepatic gallbladder drainage (PTGBD) in patients who are truly not suitable for surgery due to severe illness or uncontrolled sepsis 1, 2
Interventional gastroenterologists for endoscopic alternatives including endoscopic transpapillary gallbladder drainage and ultrasound-guided transmural gallbladder drainage, though these should only be performed in high-volume centers by skilled endoscopists 2, 3
Acute care surgeons are increasingly involved in the management of hepatopancreatobiliary emergencies, working alongside HPB surgeons when available 3, 4
Important Clinical Considerations
Do not delay surgical referral based solely on age or comorbidities, as evidence shows early laparoscopic cholecystectomy is safe and effective even in patients over 80 years old and those with significant comorbidities 1, 2
Avoid overuse of gallbladder drainage procedures in patients who could safely undergo surgery, as drainage leads to higher mortality rates, longer hospital stays, and increased readmissions compared to early surgical intervention 2
The distinction between "high-risk patients" and "patients not suitable for surgery" is critical: high-risk patients should still undergo surgery, while only those truly unfit for surgery (based on specific surgeon judgment and clinical conditions not classifiable by scores) should receive alternative drainage procedures 1