[Acute cholecystitis: primarily conservative or operative approach?].

Area of Science:

• Surgical Gastroenterology
• Abdominal Surgery
• Clinical Trials

Background:

• Acute cholecystitis is a frequent surgical emergency.
• Laparoscopic cholecystectomy is the standard treatment.
• Optimal surgical timing remains debated, with early/immediate approaches showing promise.

Purpose of the Study:

• To evaluate the optimal timing for laparoscopic cholecystectomy in acute cholecystitis.
• To compare early/immediate surgery versus delayed surgery after antibiotic treatment.
• To address limitations in existing meta-analyses and guidelines.

Main Methods:

• Prospective, multicenter, randomized controlled trial (ACDC trial).
• Comparison of different surgical timing strategies for acute cholecystitis.
• Inclusion of immediate cholecystectomy within 24 hours of diagnosis.

Main Results:

• Existing meta-analyses have limitations due to small sample sizes and varied designs.
• International guidelines suggest early cholecystectomy.
• The concept of immediate cholecystectomy (within 24h) is not yet widely considered.

Conclusions:

• Further research, particularly the ACDC trial, is needed to definitively establish the best surgical timing for acute cholecystitis.
• Early or immediate laparoscopic cholecystectomy may offer benefits over delayed procedures.
• Clarification of surgical timing will refine treatment protocols for this common condition.