Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Area of Science:

• Gastroenterology
• Surgical Oncology

Background:

• Acute acalculous cholecystitis (AAC) comprises 5-10% of acute cholecystitis cases.
• The efficacy of interval cholecystectomy in AAC patients remains uncertain.

Purpose of the Study:

• To retrospectively analyze the outcomes of AAC patients treated at our institution over a 5-year period.
• To evaluate the safety and necessity of interval cholecystectomy in AAC management.

Main Methods:

• Patient identification through hospital coding using keywords: "acalculous cholecystitis, cholecystostomy, and gall bladder perforation."
• Retrospective review of hospital records for follow-up data collection.

Main Results:

• 33 AAC patients were followed for a median of 18 months; median age was 70, ASA grade 3.
• Primary treatments included antibiotics (70%), percutaneous cholecystostomy (21%), and laparoscopic cholecystectomy (9%).
• 90-day mortality was 30%, significantly correlated with higher ASA grades (3-5); 6% experienced recurrent AAC, managed non-operatively.

Conclusions:

• Antibiotics and cholecystostomy are primary AAC management strategies.
• Comorbid status significantly impacts AAC-related mortality.
• Avoiding interval cholecystectomy in recovered AAC patients is suggested due to their high surgical risk profile.