Abstract
Background: Treatment of acute cholecytitis has for a long time been a subject of discussion. The proponents of a conservative approach with antibiotics and analgetics claim that immediate surgery in old and reduced patients results in higher morbidity and mortality compared to non-operative treatment; some also claim that immediate cholecystectomy leads to many unnecessary operations because a large number of these patients never get further complications from their gallstone disease. Those in favour of immediate surgery maintain that the procedure is safe and that many of the patients treated conservatively get relapses with pain, recurring cholecystitis or pancreatitis. The aim of our study was to evaluate the treatment of patients with acute cholecystitis at Aker University Hospital.
Materials and methods: Retrospective study based on the medical records of all patients admitted to Aker University Hospital with primary acute cholecystitis in the period from January 2000 through December 2002. Immediate cholecystectomy (group 1), delayed surgery (group 2), and conservative treatment without planned surgery (group 3) were compared.
Results: Two hundred six patients were treated, 131 (67 %) were female. Median age was 62 (21-96) years. Fourty-six (22 %) received acute surgery, 32 (16 %) delayed surgery and 128 (62 %) were treated conservatively without later planned operation. Median age in the three groups was 48 (21-84) years, 51 (25-82) years and 72 (23-96) years, respectively. There was no significant difference in the occurrence of complications between patients that received immediate (group 1) and delayed (group 2) cholecystectomy. Laparoscopic cholecystectomi was used frequently in both groups (80 % vs. 84 %). There was no difference in converting rate (7 % vs. 9 %) or duration of operation (median 99 minutes vs. 107 minutes). Of 160 patients treated conservatively (group 2 and 3), 43 (27 %) had to be readmitted because of recurrent cholecystitis (38 patients) or pain (5 patients). Sixteen (13 %) patients treated conservatively (group 3) were subsequently operated during the observation period.
Conclusion: The majority of the patients were treated conservatively without delayed surgery. Those who were operated à chaud or à froid were considerably younger than those who were not operated. More than one fourth of those treated non-operatively had to be readmitted, mainly because of recurrent cholecystitis. Immediate operation was not associated with with more per- or post operative complications than delayed operation. More patients should probably be treated with immediate cholecystectomy.