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ADVANCES IN THE MANAGEMENT OF ACUTE CHOLECYSTITIS
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Stanley W. Ashley |
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Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School |
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| Approximately 1 million cholecystectomies are performed annually for acute cholecystitis in the United States. Although the majority of these are performed laparoscopically, approximately 9.5% are converted to open procedures and this is associated with a 1.3-fold increase in operative morbidity. This discussion will review recent advances and lessons learned in the management of acute cholecystitis including: early operation versus conservative management; predictors of conversion to open cholecystectomy; avoiding operative difficulty in acute cholecystitis including the role of percutaneous cholecystostomy; special operative considerations and adjustments in acute cholecystitis; the SAGES safe cholecystectomy program; the critical view of safety; the recognition of aberrant anatomy; the use of intraoperative time outs; the role of intraoperative imaging; and strategies for the difficult cholecystectomy including subtotal cholecystectomy. It is hoped that this will stimulate discussion and sharing of best practices with our international colleagues. |
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