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Acute CholecystitisA Review

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Abstract

Importance  Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year.

Observations  Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of maternal-fetal complications (1.6% for early vs 18.4% for delayed) and is recommended during all trimesters. In people older than 65 years of age, laparoscopic cholecystectomy is associated with lower mortality at 2-year follow-up (15.2%) compared with nonoperative management (29.3%). A percutaneous cholecystostomy tube, in which a drainage catheter is placed in the gallbladder lumen under image guidance, is an effective therapy for patients with an exceptionally high perioperative risk. However, percutaneous cholecystostomy tube placement in a randomized trial was associated with higher rates of postprocedural complications (65%) compared with laparoscopic cholecystectomy (12%). For patients with acalculous acute cholecystitis, percutaneous cholecystostomy tube should be reserved for patients who are severely ill at the time of diagnosis; all others should undergo a laparoscopic cholecystectomy.

Conclusions and Relevance  Acute cholecystitis, typically due to gallstone obstruction of the cystic duct, affects approximately 200 000 people in the US annually. In most patient populations, laparoscopic cholecystectomy, performed within 3 days of diagnosis, is the first-line therapy for acute cholecystitis.

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Article Information

Corresponding Author: Anthony Charles, MD, MPH, Department of Surgery, University of North Carolina, 4008 Burnett Womack Bldg, CB 7228, Chapel Hill, NC 27599 (anthony_charles@med.unc.edu).

Accepted for Publication: February 7, 2022.

Author Contributions: Dr Charles had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Gallaher.

Administrative, technical, or material support: All authors.

Conflict of Interest Disclosures: None reported.

Disclaimer: Dr Charles is an Associate Editor of JAMA, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Additional Contributions: We thank Charlotte Smith, a second-year medical student at the University of North Carolina School of Medicine, for her original artistic rendering of the pathogenesis of acute cholecystitis.

References
1.
Indar  AA , Beckingham  IJ .  Acute cholecystitis.   BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639PubMedGoogle ScholarCrossref
2.
Everhart  JE , Khare  M , Hill  M , Maurer  KR .  Prevalence and ethnic differences in gallbladder disease in the United States.   Gastroenterology. 1999;117(3):632-639. doi:10.1016/S0016-5085(99)70456-7PubMedGoogle ScholarCrossref
3.
Sandler  RS , Everhart  JE , Donowitz  M ,  et al.  The burden of selected digestive diseases in the United States.   Gastroenterology. 2002;122(5):1500-1511. doi:10.1053/gast.2002.32978PubMedGoogle ScholarCrossref
4.
Wadhwa  V , Jobanputra  Y , Garg  SK , Patwardhan  S , Mehta  D , Sanaka  MR .  Nationwide trends of hospital admissions for acute cholecystitis in the United States.   Gastroenterol Rep (Oxf). 2017;5(1):36-42. doi:10.1093/gastro/gow015PubMedGoogle ScholarCrossref
5.
Cafasso  DE , Smith  RR .  Symptomatic cholelithiasis and functional disorders of the biliary tract.   Surg Clin North Am. 2014;94(2):233-256. doi:10.1016/j.suc.2013.12.001PubMedGoogle ScholarCrossref
6.
Shaffer  EA .  Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?   Curr Gastroenterol Rep. 2005;7(2):132-140. doi:10.1007/s11894-005-0051-8PubMedGoogle ScholarCrossref
7.
Owen  CC , Jain  R .  Acute acalculous cholecystitis.   Curr Treat Options Gastroenterol. 2005;8(2):99-104. doi:10.1007/s11938-005-0001-4PubMedGoogle ScholarCrossref
8.
Stinton  LM , Shaffer  EA .  Epidemiology of gallbladder disease: cholelithiasis and cancer.   Gut Liver. 2012;6(2):172-187. doi:10.5009/gnl.2012.6.2.172PubMedGoogle ScholarCrossref
9.
Strasberg  SM .  Clinical practice: acute calculous cholecystitis.   N Engl J Med. 2008;358(26):2804-2811. doi:10.1056/NEJMcp0800929PubMedGoogle ScholarCrossref
10.
Barie  PS , Eachempati  SR .  Acute acalculous cholecystitis.   Gastroenterol Clin North Am. 2010;39(2):343-357. doi:10.1016/j.gtc.2010.02.012Google ScholarCrossref
11.
Ganpathi  IS , Diddapur  RK , Eugene  H , Karim  M .  Acute acalculous cholecystitis: challenging the myths.   HPB (Oxford). 2007;9(2):131-134. doi:10.1080/13651820701315307PubMedGoogle ScholarCrossref
12.
Everhart  JE , Yeh  F , Lee  ET ,  et al.  Prevalence of gallbladder disease in American Indian populations: findings from the Strong Heart Study.   Hepatology. 2002;35(6):1507-1512. doi:10.1053/jhep.2002.33336PubMedGoogle ScholarCrossref
13.
Miquel  JF , Covarrubias  C , Villaroel  L ,  et al.  Genetic epidemiology of cholesterol cholelithiasis among Chilean Hispanics, Amerindians, and Maoris.   Gastroenterology. 1998;115(4):937-946. doi:10.1016/S0016-5085(98)70266-5PubMedGoogle ScholarCrossref
14.
Rahman  GA .  Cholelithiasis and cholecystitis: changing prevalence in an African community.   J Natl Med Assoc. 2005;97(11):1534-1538.PubMedGoogle Scholar
15.
Huang  J , Chang  C-H , Wang  J-L ,  et al.  Nationwide epidemiological study of severe gallstone disease in Taiwan.   BMC Gastroenterol. 2009;9(1):63. doi:10.1186/1471-230X-9-63PubMedGoogle ScholarCrossref
16.
Cha  BH , Jang  MJ , Lee  SH .  Alcohol consumption can reduce the risk of gallstone disease: a systematic review with a dose-response meta-analysis of case-control and cohort studies.   Gut Liver. 2019;13(1):114-131. doi:10.5009/gnl18278PubMedGoogle ScholarCrossref
17.
Di Ciaula  A , Garruti  G , Frühbeck  G ,  et al.  The role of diet in the pathogenesis of cholesterol gallstones.   Curr Med Chem. 2019;26(19):3620-3638. doi:10.2174/0929867324666170530080636PubMedGoogle ScholarCrossref
18.
Svensson  J , Makin  E .  Gallstone disease in children.   Semin Pediatr Surg. 2012;21(3):255-265. doi:10.1053/j.sempedsurg.2012.05.008PubMedGoogle ScholarCrossref
19.
Martins  RA , Soares  RS , Vito  FBD ,  et al.  Cholelithiasis and its complications in sickle cell disease in a university hospital.   Rev Bras Hematol Hemoter. 2017;39(1):28-31. doi:10.1016/j.bjhh.2016.09.009PubMedGoogle ScholarCrossref
20.
Ko  CW , Beresford  SA , Schulte  SJ , Matsumoto  AM , Lee  SP .  Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy.   Hepatology. 2005;41(2):359-365. doi:10.1002/hep.20534PubMedGoogle ScholarCrossref
21.
Bolukbas  FF , Bolukbas  C , Horoz  M ,  et al.  Risk factors associated with gallstone and biliary sludge formation during pregnancy.   J Gastroenterol Hepatol. 2006;21(7):1150-1153. doi:10.1111/j.1440-1746.2006.04444.xPubMedGoogle ScholarCrossref
22.
Ruhl  CE , Everhart  JE .  Relationship of serum leptin concentration and other measures of adiposity with gallbladder disease.   Hepatology. 2001;34(5):877-883. doi:10.1053/jhep.2001.29005PubMedGoogle ScholarCrossref
23.
Sneineh  MA , Harel  L , Elnasasra  A ,  et al.  Increased incidence of symptomatic cholelithiasis after bariatric Roux-En-Y gastric bypass and previous bariatric surgery: a single center experience.   Obes Surg. 2020;30(3):846-850. doi:10.1007/s11695-019-04366-6PubMedGoogle ScholarCrossref
24.
Li  VK , Pulido  N , Fajnwaks  P , Szomstein  S , Rosenthal  R , Martinez-Duartez  P .  Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy.  Published correction appears in Surg Endosc. 2009;23(7):1645.  Surg Endosc. 2009;23(7):1640-1644. doi:10.1007/s00464-008-0204-6PubMedGoogle ScholarCrossref
25.
Azarkar  G , Birjand  MM , Ehsanbakhsh  A , Bijari  B , Abedini  MR , Ziaee  M .  Ceftriaxone-associated nephrolithiasis and gallstone in adults.   Drug Healthc Patient Saf. 2018;10:103-108. doi:10.2147/DHPS.S183892PubMedGoogle ScholarCrossref
26.
Bornschein  J , Drozdov  I , Malfertheiner  P .  Octreotide LAR: safety and tolerability issues.   Expert Opin Drug Saf. 2009;8(6):755-768. doi:10.1517/14740330903379525PubMedGoogle ScholarCrossref
27.
Aune  D , Vatten  LJ .  Diabetes mellitus and the risk of gallbladder disease: a systematic review and meta-analysis of prospective studies.   J Diabetes Complications. 2016;30(2):368-373. doi:10.1016/j.jdiacomp.2015.11.012PubMedGoogle ScholarCrossref
28.
Chen  CH , Lin  CL , Hsu  CY , Kao  CH .  Association between type I and II diabetes with gallbladder stone disease.   Front Endocrinol (Lausanne). 2018;9:720. doi:10.3389/fendo.2018.00720PubMedGoogle ScholarCrossref
29.
Faillie  J-L , Yu  OH , Yin  H , Hillaire-Buys  D , Barkun  A , Azoulay  L .  Association of bile duct and gallbladder diseases with the use of incretin-based drugs in patients with type 2 diabetes mellitus.   JAMA Intern Med. 2016;176(10):1474-1481. doi:10.1001/jamainternmed.2016.1531PubMedGoogle ScholarCrossref
30.
Huffman  JL , Schenker  S .  Acute acalculous cholecystitis: a review.   Clin Gastroenterol Hepatol. 2010;8(1):15-22. doi:10.1016/j.cgh.2009.08.034PubMedGoogle ScholarCrossref
31.
Pelinka  LE , Schmidhammer  R , Hamid  L , Mauritz  W , Redl  H .  Acute acalculous cholecystitis after trauma: a prospective study.   J Trauma. 2003;55(2):323-329. doi:10.1097/01.TA.0000054648.26933.21PubMedGoogle ScholarCrossref
32.
Walsh  K , Goutos  I , Dheansa  B .  Acute acalculous cholecystitis in burns: a review.   J Burn Care Res. 2018;39(5):724-728. doi:10.1093/jbcr/irx055PubMedGoogle ScholarCrossref
33.
Passage  J , Joshi  P , Mullany  DV .  Acute cholecystitis complicating cardiac surgery: case series involving more than 16,000 patients.   Ann Thorac Surg. 2007;83(3):1096-1101. doi:10.1016/j.athoracsur.2006.09.048PubMedGoogle ScholarCrossref
34.
Mann  NS .  Cholecystitis and cholelithiasis in patients on total parenteral nutrition: systematic evaluation of 518 patients with meta-analysis.   Int Med J. 2013;20(1):18-19.Google Scholar
35.
Roslyn  JJ , DenBesten  L , Thompson  JE  Jr , Silverman  BF .  Roles of lithogenic bile and cystic duct occlusion in the pathogenesis of acute cholecystitis.   Am J Surg. 1980;140(1):126-130. doi:10.1016/0002-9610(80)90428-6PubMedGoogle ScholarCrossref
36.
Kaplan  U , Handler  C , Chazan  B ,  et al.  The bacteriology of acute cholecystitis: comparison of bile cultures and clinical outcomes in diabetic and non-diabetic patients.   World J Surg. 2021;45(8):2426-2431. doi:10.1007/s00268-021-06107-2PubMedGoogle ScholarCrossref
37.
Adachi  T , Eguchi  S , Muto  Y .  Pathophysiology and pathology of acute cholecystitis: a secondary publication of the Japanese version from 1992.   J Hepatobiliary Pancreat Sci. Published online February 11, 2021. doi:10.1002/jhbp.912 PubMedGoogle Scholar
38.
Laurila  J , Syrjälä  H , Laurila  PA , Saarnio  J , Ala-Kokko  TI .  Acute acalculous cholecystitis in critically ill patients.   Acta Anaesthesiol Scand. 2004;48(8):986-991. doi:10.1111/j.0001-5172.2004.00426.xPubMedGoogle ScholarCrossref
39.
Jain  A , Mehta  N , Secko  M ,  et al.  History, physical examination, laboratory testing, and emergency department ultrasonography for the diagnosis of acute cholecystitis.   Acad Emerg Med. 2017;24(3):281-297. doi:10.1111/acem.13132PubMedGoogle ScholarCrossref
40.
Vahed  LK , Khedmat  L .  Frequency of symptoms associated with gallstone disease: a hospital-based cross sectional study.   Eur J Transl Myol. 2018;28(2):7412. doi:10.4081/ejtm.2018.7412PubMedGoogle Scholar
41.
Trowbridge  RL , Rutkowski  NK , Shojania  KG .  Does this patient have acute cholecystitis?   JAMA. 2003;289(1):80-86. doi:10.1001/jama.289.1.80PubMedGoogle ScholarCrossref
42.
Yokoe  M , Hata  J , Takada  T ,  et al.  Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).   J Hepatobiliary Pancreat Sci. 2018;25(1):41-54. doi:10.1002/jhbp.515PubMedGoogle ScholarCrossref
43.
Hirota  M , Takada  T , Kawarada  Y ,  et al.  Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines.   J Hepatobiliary Pancreat Surg. 2007;14(1):78-82. doi:10.1007/s00534-006-1159-4PubMedGoogle ScholarCrossref
44.
Yokoe  M , Takada  T , Mayumi  T ,  et al.  Accuracy of the Tokyo guidelines for the diagnosis of acute cholangitis and cholecystitis taking into consideration the clinical practice pattern in Japan.   J Hepatobiliary Pancreat Sci. 2011;18(2):250-257. doi:10.1007/s00534-010-0338-5PubMedGoogle ScholarCrossref
45.
Naidu  K , Beenen  E , Gananadha  S , Mosse  C .  The yield of fever, inflammatory markers and ultrasound in the diagnosis of acute cholecystitis: a validation of the 2013 Tokyo guidelines.   World J Surg. 2016;40(12):2892-2897. doi:10.1007/s00268-016-3660-5PubMedGoogle ScholarCrossref
46.
Kiewiet  JJ , Leeuwenburgh  MM , Bipat  S , Bossuyt  PM , Stoker  J , Boermeester  MA .  A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis.   Radiology. 2012;264(3):708-720. doi:10.1148/radiol.12111561PubMedGoogle ScholarCrossref
47.
Anderson  SW , Lucey  BC , Varghese  JC , Soto  JA .  Accuracy of MDCT in the diagnosis of choledocholithiasis.   AJR Am J Roentgenol. 2006;187(1):174-180. doi:10.2214/AJR.05.0459PubMedGoogle ScholarCrossref
48.
Håkansson  K , Leander  P , Ekberg  O , Håkansson  HO .  MR imaging in clinically suspected acute cholecystitis: a comparison with ultrasonography.   Acta Radiol. 2000;41(4):322-328. doi:10.1080/028418500127345587PubMedGoogle ScholarCrossref
49.
Scruggs  W , Fox  JC , Potts  B ,  et al.  Accuracy of ED bedside ultrasound for identification of gallstones: retrospective analysis of 575 studies.  Published correction appears in West J Emerg Med. 2008;9(2):129.  West J Emerg Med. 2008;9(1):1-5.PubMedGoogle Scholar
50.
Paulson  EK .  Acute cholecystitis: CT findings.   Semin Ultrasound CT MR. 2000;21(1):56-63. doi:10.1016/S0887-2171(00)90013-1PubMedGoogle ScholarCrossref
51.
Tulchinsky  M , Colletti  PM , Allen  TW .  Hepatobiliary scintigraphy in acute cholecystitis.   Semin Nucl Med. 2012;42(2):84-100. doi:10.1053/j.semnuclmed.2011.10.005PubMedGoogle ScholarCrossref
52.
Dillehay  G , Bar-Sever  Z , Brown  M ,  et al.  Appropriate use criteria for hepatobiliary scintigraphy in abdominal pain: summary and excerpts.   J Nucl Med. 2017;58(6):9N-11N.PubMedGoogle Scholar
53.
Adusumilli  S , Siegelman  ES .  MR imaging of the gallbladder.   Magn Reson Imaging Clin N Am. 2002;10(1):165-184. doi:10.1016/S1064-9689(03)00055-2PubMedGoogle ScholarCrossref
54.
Tonolini  M , Ravelli  A , Villa  C , Bianco  R .  Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings.   Emerg Radiol. 2012;19(4):341-348. doi:10.1007/s10140-012-1038-zPubMedGoogle ScholarCrossref
55.
Hjartarson  JH , Hannesson  P , Sverrisson  I , Blöndal  S , Ívarsson  B , Björnsson  ES .  The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis.   Scand J Gastroenterol. 2016;51(10):1249-1256. doi:10.1080/00365521.2016.1182584PubMedGoogle ScholarCrossref
56.
Banz  V , Gsponer  T , Candinas  D , Güller  U .  Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy.   Ann Surg. 2011;254(6):964-970. doi:10.1097/SLA.0b013e318228d31cPubMedGoogle ScholarCrossref
57.
Nuzzo  G , Giuliante  F , Giovannini  I ,  et al.  Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies.   Arch Surg. 2005;140(10):986-992. doi:10.1001/archsurg.140.10.986PubMedGoogle ScholarCrossref
58.
Elshaer  M , Gravante  G , Thomas  K , Sorge  R , Al-Hamali  S , Ebdewi  H .  Subtotal cholecystectomy for “difficult gallbladders”: systematic review and meta-analysis.   JAMA Surg. 2015;150(2):159-168. doi:10.1001/jamasurg.2014.1219PubMedGoogle ScholarCrossref
59.
Toro  A , Teodoro  M , Khan  M ,  et al.  Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review.   World J Emerg Surg. 2021;16(1):45. doi:10.1186/s13017-021-00392-xPubMedGoogle ScholarCrossref
60.
van Dijk  AH , Donkervoort  SC , Lameris  W ,  et al.  Short- and long-term outcomes after a reconstituting and fenestrating subtotal cholecystectomy.   J Am Coll Surg. 2017;225(3):371-379. doi:10.1016/j.jamcollsurg.2017.05.016PubMedGoogle ScholarCrossref
61.
Simorov  A , Ranade  A , Parcells  J ,  et al.  Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study.   Am J Surg. 2013;206(6):935-940. doi:10.1016/j.amjsurg.2013.08.019PubMedGoogle ScholarCrossref
62.
Schlottmann  F , Gaber  C , Strassle  PD , Patti  MG , Charles  AG .  Cholecystectomy vs cholecystostomy for the management of acute cholecystitis in elderly patients.   J Gastrointest Surg. 2019;23(3):503-509. doi:10.1007/s11605-018-3863-1PubMedGoogle ScholarCrossref
63.
McMahon  AJ , Fischbacher  CM , Frame  SH , MacLeod  MC .  Impact of laparoscopic cholecystectomy: a population-based study.   Lancet. 2000;356(9242):1632-1637. doi:10.1016/S0140-6736(00)03156-1PubMedGoogle ScholarCrossref
64.
Chen  AY , Daley  J , Pappas  TN , Henderson  WG , Khuri  SF .  Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes.   Ann Surg. 1998;227(1):12-24. doi:10.1097/00000658-199801000-00003PubMedGoogle ScholarCrossref
65.
Pucher  PH , Brunt  LM , Davies  N ,  et al.  Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis.   Surg Endosc. 2018;32(5):2175-2183. doi:10.1007/s00464-017-5974-2Google ScholarCrossref
66.
Gutt  CN , Encke  J , Köninger  J ,  et al.  Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304).   Ann Surg. 2013;258(3):385-393. doi:10.1097/SLA.0b013e3182a1599bPubMedGoogle ScholarCrossref
67.
Blohm  M , Österberg  J , Sandblom  G , Lundell  L , Hedberg  M , Enochsson  L .  The sooner, the better? the importance of optimal timing of cholecystectomy in acute cholecystitis: data from the National Swedish Registry for Gallstone Surgery, GallRiks.   J Gastrointest Surg. 2017;21(1):33-40. doi:10.1007/s11605-016-3223-yPubMedGoogle ScholarCrossref
68.
Polo  M , Duclos  A , Polazzi  S ,  et al.  Acute cholecystitis—optimal timing for early cholecystectomy: a French nationwide study.   J Gastrointest Surg. 2015;19(11):2003-2010. doi:10.1007/s11605-015-2909-xPubMedGoogle ScholarCrossref
69.
Altieri  MS , Brunt  LM , Yang  J , Zhu  C , Talamini  MA , Pryor  AD .  Early cholecystectomy (< 72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York.   Surg Endosc. 2020;34(7):3051-3056. doi:10.1007/s00464-019-07049-6PubMedGoogle ScholarCrossref
70.
Gahagan  JV , Hanna  MH , Whealon  MD ,  et al.  Racial disparities in access and outcomes of cholecystectomy in the United States.   Am Surg. 2016;82(10):921-925. doi:10.1177/000313481608201013PubMedGoogle ScholarCrossref
71.
Overby  DW , Apelgren  KN , Richardson  W , Fanelli  R ; Society of American Gastrointestinal and Endoscopic Surgeons.  SAGES guidelines for the clinical application of laparoscopic biliary tract surgery.   Surg Endosc. 2010;24(10):2368-2386. doi:10.1007/s00464-010-1268-7PubMedGoogle ScholarCrossref
72.
Hu  ASY , Menon  R , Gunnarsson  R , de Costa  A .  Risk factors for conversion of laparoscopic cholecystectomy to open surgery—a systematic literature review of 30 studies.   Am J Surg. 2017;214(5):920-930. doi:10.1016/j.amjsurg.2017.07.029PubMedGoogle ScholarCrossref
73.
Goonawardena  J , Gunnarsson  R , de Costa  A .  Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors.   Am J Surg. 2015;210(3):492-500. doi:10.1016/j.amjsurg.2015.04.003PubMedGoogle ScholarCrossref
74.
Machado  NO .  Biliary complications postlaparoscopic cholecystectomy: mechanism, preventive measures, and approach to management: a review.   Diagn Ther Endosc. 2011;2011:967017. PubMedGoogle Scholar
75.
McGillicuddy  EA , Schuster  KM , Barre  K ,  et al.  Non-operative management of acute cholecystitis in the elderly.   Br J Surg. 2012;99(9):1254-1261. doi:10.1002/bjs.8836PubMedGoogle ScholarCrossref
76.
Hazzan  D , Geron  N , Golijanin  D , Reissman  P , Shiloni  E .  Laparoscopic cholecystectomy in octogenarians.   Surg Endosc. 2003;17(5):773-776. doi:10.1007/s00464-002-8529-zPubMedGoogle ScholarCrossref
77.
Riall  TS , Zhang  D , Townsend  CM , Kuo  Y-F , Goodwin  JS .  Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost.   J Am Coll Surg. 2010;210(5):668-677. doi:10.1016/j.jamcollsurg.2009.12.031Google ScholarCrossref
78.
Wiggins  T , Markar  SR , Mackenzie  H ,  et al.  Evolution in the management of acute cholecystitis in the elderly: population-based cohort study.   Surg Endosc. 2018;32(10):4078-4086. doi:10.1007/s00464-018-6092-5PubMedGoogle ScholarCrossref
79.
Tolcher  MC , Fisher  WE , Clark  SL .  Nonobstetric surgery during pregnancy.   Obstet Gynecol. 2018;132(2):395-403. doi:10.1097/AOG.0000000000002748PubMedGoogle ScholarCrossref
80.
 Committee opinion No. 696: nonobstetric surgery during pregnancy.   Obstet Gynecol. 2017;129(4):777-778. doi:10.1097/AOG.0000000000002014PubMedGoogle ScholarCrossref
81.
Pearl  JP , Price  RR , Tonkin  AE , Richardson  WS , Stefanidis  D .  SAGES guidelines for the use of laparoscopy during pregnancy.   Surg Endosc. 2017;31(10):3767-3782. doi:10.1007/s00464-017-5637-3Google ScholarCrossref
82.
Rios-Diaz  AJ , Oliver  EA , Bevilacqua  LA ,  et al.  Is it safe to manage acute cholecystitis nonoperatively during pregnancy?: a nationwide analysis of morbidity according to management strategy.   Ann Surg. 2020;272(3):449-456. doi:10.1097/SLA.0000000000004210PubMedGoogle ScholarCrossref
83.
Balinskaite  V , Bottle  A , Sodhi  V ,  et al.  The risk of adverse pregnancy outcomes following nonobstetric surgery during pregnancy: estimates from a retrospective cohort study of 6.5 million pregnancies.   Ann Surg. 2017;266(2):260-266. doi:10.1097/SLA.0000000000001976PubMedGoogle ScholarCrossref
84.
Cheng  V , Matsushima  K , Sandhu  K ,  et al.  Surgical trends in the management of acute cholecystitis during pregnancy.   Surg Endosc. 2021;35(10):5752-5759. doi:10.1007/s00464-020-08054-wGoogle ScholarCrossref
85.
Delis  S , Bakoyiannis  A , Madariaga  J , Bramis  J , Tassopoulos  N , Dervenis  C .  Laparoscopic cholecystectomy in cirrhotic patients: the value of MELD score and Child-Pugh classification in predicting outcome.   Surg Endosc. 2010;24(2):407-412. doi:10.1007/s00464-009-0588-yPubMedGoogle ScholarCrossref
86.
Dolejs  SC , Beane  JD , Kays  JK , Ceppa  EP , Zarzaur  BL .  The Model for End-stage Liver Disease predicts outcomes in patients undergoing cholecystectomy.   Surg Endosc. 2017;31(12):5192-5200. doi:10.1007/s00464-017-5587-9PubMedGoogle ScholarCrossref
87.
Shahait  A , Mesquita-Neto  JWB , Hasnain  MR ,  et al.  Outcomes of cholecystectomy in US veterans with cirrhosis: predicting outcomes using nomogram.   Am J Surg. 2021;221(3):538-542. doi:10.1016/j.amjsurg.2020.12.031PubMedGoogle ScholarCrossref
88.
Baron  TH , Grimm  IS , Swanstrom  LL .  Interventional approaches to gallbladder disease.   N Engl J Med. 2015;373(4):357-365. doi:10.1056/NEJMra1411372PubMedGoogle ScholarCrossref
89.
James  TW , Krafft  M , Croglio  M , Nasr  J , Baron  T .  EUS-guided gallbladder drainage in patients with cirrhosis: results of a multicenter retrospective study.   Endosc Int Open. 2019;7(9):E1099-E1104. doi:10.1055/a-0965-6662PubMedGoogle Scholar
90.
Strasberg  SM , Pucci  MJ , Brunt  LM , Deziel  DJ .  Subtotal cholecystectomy—“fenestrating” vs “reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions.   J Am Coll Surg. 2016;222(1):89-96. doi:10.1016/j.jamcollsurg.2015.09.019PubMedGoogle ScholarCrossref
91.
Sabour  AF , Matsushima  K , Love  BE ,  et al.  Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis.   Surgery. 2020;167(3):569-574. doi:10.1016/j.surg.2019.11.004PubMedGoogle ScholarCrossref
92.
Gonzalez-Urquijo  M , Rodarte-Shade  M , Lozano-Balderas  G , Gil-Galindo  G .  Cholecystoenteric fistula with and without gallstone ileus: a case series.   Hepatobiliary Pancreat Dis Int. 2020;19(1):36-40. doi:10.1016/j.hbpd.2019.12.004PubMedGoogle ScholarCrossref
93.
Gomi  H , Solomkin  JS , Schlossberg  D ,  et al.  Tokyo guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis.   J Hepatobiliary Pancreat Sci. 2018;25(1):3-16. doi:10.1002/jhbp.518PubMedGoogle ScholarCrossref
94.
Regimbeau  JM , Fuks  D , Pautrat  K ,  et al; FRENCH Study Group.  Effect of postoperative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a randomized clinical trial.   JAMA. 2014;312(2):145-154. doi:10.1001/jama.2014.7586PubMedGoogle ScholarCrossref
95.
Loozen  CS , Kortram  K , Kornmann  VN ,  et al.  Randomized clinical trial of extended versus single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis.   Br J Surg. 2017;104(2):e151-e157. doi:10.1002/bjs.10406PubMedGoogle ScholarCrossref
96.
Smith  TJ , Manske  JG , Mathiason  MA , Kallies  KJ , Kothari  SN .  Changing trends and outcomes in the use of percutaneous cholecystostomy tubes for acute cholecystitis.   Ann Surg. 2013;257(6):1112-1115. doi:10.1097/SLA.0b013e318274779cPubMedGoogle ScholarCrossref
97.
Akhan  O , Akinci  D , Özmen  MN .  Percutaneous cholecystostomy.   Eur J Radiol. 2002;43(3):229-236. doi:10.1016/S0720-048X(02)00158-4PubMedGoogle ScholarCrossref
98.
Dimou  FM , Adhikari  D , Mehta  HB , Riall  TS .  Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis.   J Am Coll Surg. 2017;224(4):502-511.e1. doi:10.1016/j.jamcollsurg.2016.12.021PubMedGoogle ScholarCrossref
99.
Gurusamy  KS , Rossi  M , Davidson  BR .  Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis.   Cochrane Database Syst Rev. 2013;(8):CD007088. PubMedGoogle Scholar
100.
Loozen  CS , van Santvoort  HC , van Duijvendijk  P ,  et al.  Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial.   BMJ. 2018;363:k3965. doi:10.1136/bmj.k3965PubMedGoogle Scholar
101.
Sanaiha  Y , Juo  YY , Rudasill  SE ,  et al.  Percutaneous cholecystostomy for grade III acute cholecystitis is associated with worse outcomes.   Am J Surg. 2020;220(1):197-202. doi:10.1016/j.amjsurg.2019.11.025PubMedGoogle ScholarCrossref
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