Gallstones affect around 10-15 per cent of the UK population. Many of us will get by without serious symptoms, but in some cases, gallstones can block the gallbladder, causing acute cholecystitis. In this article, consultant hepatobiliary and general surgeon, Professor Brian Davidson explains the debate over when to treat acute cholecystitis surgically, and what technique is best.
What is acute cholecystitis?
Acute cholecystitis is a sudden inflammation of the gallbladder. It is usually caused by a blockage due to gallstones – each year about 1 per cent of patients with known gallstones will experience acute cholecystitis.
Acute cholecystitis is a serious condition and is one of the main reasons for hospital admission in the UK. It can lead to life-threatening problems such as empyema, gallbladder gangrene and perforation of the gallbladder. Therefore treatment needs to be started quickly after symptoms become apparent and the cause is found.
How is acute cholecystitis treated?
Ultimately, cholecystitis requires surgical removal of the gallbladder, known as a cholecystectomy.
There are two main ways to remove the gallbladder. For a long time, open surgery was the only approach available, and is still the approach that most surgeons are familiar with. However, the development of laparoscopy has made it possible to carry out gallbladder surgery much more safely. A surgeon trained in this technique should offer to carry out your procedure laparoscopically.
When should I have the operation?
There is a big debate among surgeons about when exactly to remove the gallbladder.
The 'delayed' approach generally involves treating the gallbladder with bed rest, gut rest, and antibiotics, then operating approximately six to eight weeks later. The rationale for this approach is the assumption that operating on an inflamed bladder involves a higher risk of complications including bile duct injury.
The 'early' approach involves removing the gallbladder the first time you are admitted to hospital for acute cholecystitis. Those in support of this approach argue that it exposes you to less risk of biliary sepsis and other complications if best rest and antibiotics are not successful.
So, which is best?
Previously this would have been impossible to answer. However, we now have the benefit of multiple randomised control trials (RCTs) and population studies to compare the two approaches. Looking at the available evidence, it is clear that the early approach is preferable to a delayed approach, when the surgery is performed via laparoscopy. The early approach ultimately involves a lower chance of hospital readmission and reduces your overall hospital stay.
How early, do we mean exactly?
'Early' is a loosely defined term, with some surgeons interpreting it as meaning within 24 hours, and others up to seven days. From the evidence we have, it appears that the most important factor is that the surgery is performed by a surgeon experienced in minimally-invasive hepatobiliary surgery.
If you require expert assistance regarding hepatobiliary issues, Professor Brian Davidson's world-leading reputation means you're in the right hands. To book an appointment with him, visit his Top Doctors profile here.