[When should cholecystectomy in acute cholecystitis be planned?]

Acute cholecystitis may be treated either by removal of the inflamed gallbladder during the acute stage of the disease or by conservative measures followed later by cholecystectomy. Many authors recommend delayed operation in view of the possibly higher postoperative mortality with early operation. 394 early cholecystectomies for acute cholecystitis have been performed between 1970 and 1979 at the University Hospital of Basle. 14 patients died postoperatively, representing a mortality rate of 3.5%. Large series in the literature show similar mortality of 3.2-4.5%. In four prospective randomized studies no significant difference of the mortality rate has been demonstrated. One retrospective study of the two methods showed a reduction in mortality rate from 7.4% for late operation to 2.7% for early cholecystectomy. Based on our own studies and on the literature, we have come to the conclusion that early cholecystectomy must be recommended for acute cholecystitis. Its advantages are shorter hospital stay, less patient discomfort since there is only one hospitalization, and reduction of costs. These advantages are also coupled with a similar or even lower mortality rate.