SEVERITY-GUIDED CHOICE OF SURGICAL STRATEGY AND BAILOUT OPTIONS IN COMPLICATED ACUTE CHOLECYSTITIS
Keywords:
acute cholecystitis; Tokyo Guidelines; laparoscopic cholecystectomy; critical view of safety; subtotal cholecystectomy; percutaneous cholecystostomy; choledocholithiasis.Abstract
Complicated acute cholecystitis (gangrene, empyema, perforation, pericholecystic abscess, Mirizzi syndrome, concomitant choledocholithiasis and cholangitis) carries a high risk of bile duct injury and postoperative morbidity. Current guidelines and reviews were analysed to outline a stepwise, severity-guided strategy. Early laparoscopic cholecystectomy suits fit patients with mild or moderate disease; in severe disease or prohibitive operative risk, gallbladder drainage followed by delayed surgery is preferred. When the critical view of safety cannot be achieved, subtotal cholecystectomy or timely conversion should replace forced dissection of Calot's triangle. Concomitant common bile duct stones are managed in one or two stages depending on local expertise and the patient's condition.
