[SURGICAL MANAGEMENT OF BILIARY TRACT INFECTIONS]

Acute cholecystitis requires a prompt diagnosis and early surgical treatment, either open or laparoscopic surgery. Currently, most of the patients can be treated by laparoscopic surgery.Delayed surgery of acute cholecystitis must be considered only if the patient has other clinical conditions such as congestive heart failure, other uncontrolled disease, and whenever cholecystitis is not complicated (epyema, perforation, gangrene, cholangitis, etc.) Percutaneous cholecystostomy by interventionist radiologist or surgical cholecystostomy must be considered in the therapeutic armamentarium in patients with poor clinical conditions. Acute cholangitis management requires a multidisciplinary team approach of internists, gastroenterologists, interventionist radiologists and surgeons. Each patient requires an integral evaluation with an initial energic medical treatment, followed by drainage of the biliary tract, ideally by endoscopic sphincterectomy or by transhepatic percutaneous drainage. Only if these procedures do not solve the patient's problem, or if its application is not possible, we proceed with an emergency surgery in order to decompress the biliary tree.