title: Percutaneous Drainage versus Emergency Cholecystectomy for the Treatment of Acute Cholecystitis in Critically Ill Patients: Does it Matter? Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial Management of acute cholecystitis in the laparoscopic era: Results of a prospective, randomized clinical trial Emergency management of diverticulitis. Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis Acute Cholecystitis: Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial (ACDC Study, NCT00447304) Conservative treatment for acute cholecystitis: clinical and radiographic predictors of failure. Acute cholecystitis: delayed surgery or observation. A randomized clinical trial. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: Non-operative management is an option in some patients Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy? Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Prospective Evaluation of Emergency Versus Delayed Laparoscopic Cholecystectomy for Early Cholecystitis Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk. Home treatment of patients with acute cholecystitis.
abstract: Background The aim if this study was to compare percutaneous drainage ( PD ) of the gallbladder to emergency cholecystectomy ( EC ) in a well-defined patient group with sepsis related to acute calculous/acalculous cholecystitis ( ACC/AAC ) . Methods Between 2001 and 2007 , all consecutive patients of our ICU treated by either PD or EC were retrospectively analyzed . Cases were collected from a prospect i ve data base . Percutaneous drainage was performed by a transhepatic route and EC by open or laparoscopic approach . Patients ’ general condition and organ dysfunction were assessed by two vali date d scoring systems ( SAPS II and SOFA , respectively ) . Morbidity , mortality , and long-term outcome were systematic ally review ed and analyzed in both groups . Results Forty-two patients [ median age = 65.5 years ( range = 32–94 ) ] were included ; 45 % underwent EC  ( ten laparoscopic , nine open ) and 55 % PD ( n = 23 ) . Both patient groups had similar preoperative characteristics .  Percutaneous drainage and EC  were successful in 91 and 100 % of patients , respectively . Organ dysfunctions were similarly improved by the third postoperative/postdrainage days . Despite undergoing PD , two patients required EC due to gangrenous cholecystitis . The conversion rate after laparoscopy was 20 % . Overall morbidity was 8.7 % after PD and 47 % after EC ( P = 0.011 ) . Major morbidity was 0 % after PD and 21 % after EC ( P = 0.034 ) . The mortality rate was not different ( 13 % after PD and 16 % after EC , P = 1.0 ) and the deaths were all related to the patients ’ preexisting disease . Hospital and ICU stays were not different . Recurrent symptoms ( 17 % ) occurred only after ACC in the PD group . Conclusions In high-risk patients , PD and EC are both efficient in the resolution of acute cholecystitis sepsis . However , EC is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible . Percutaneous drainage represents a valuable intervention , but secondary cholecystectomy is m and atory in cases of acute calculous cholecystitis Background : The role of laparoscopic cholecystectomy for acute cholecystitis is not yet clearly established . The aim of this prospect i ve r and omized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy . Methods : Between January 2001 and November 2002 , 40 patients with a diagnosis of acute cholecystitis were assigned r and omly to early laparoscopic cholecystectomy within 24 h of admission ( early group , n = 20 ) or to initial conservative treatment followed by delayed laparoscopic cholecystectomy , 6 to 12 weeks later ( delayed group , n = 20 ) . Results : There was no significant difference in the conversion rates ( early , 25 % vs delayed , 25 % ) , operating times ( early , 104 min vs delayed , 93 min ) , postoperative analgesia requirements ( early , 5.3 days vs delayed , 4.8 days ) , or postoperative complications ( early , 15 % vs delayed , 20 % ) . However , the early group had significantly more blood loss ( 228 vs 114 ml ) and shorter hospital stay ( 4.1 vs 10.1 days ) . Conclusions : Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible , offering the additional benefit of a shorter hospital stay . It should be offered to patients with acute cholecystitis , provided the surgery is performed within 72 to 96 h of the onset of symptoms Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE A prospect i ve r and omized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis . SUMMARY BACKGROUND DATA Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates . It is not known whether there is a role for initial conservative treatment followed by interval elective operation . METHOD During a 26-month period , 99 patients with a clinical diagnosis of acute cholecystitis were r and omly assigned to  early laparoscopic cholecystectomy within 72 hours of admission  ( early group , n = 49 ) or delayed interval surgery after initial medical treatment ( delayed group , n = 50 ) . Thirteen patients ( four in the early group and nine in the delayed group ) were excluded because of refusal of operation ( n = 6 ) , misdiagnosis ( n = 5 ) , contraindication for surgery ( n = 1 ) , or loss to follow-up ( n = 1 ) . RESULTS Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours ( range , 32 to 140 hours ) after admission because of spreading peritonitis ( n = 3 ) and persistent fever ( n = 5 ) . Although the delayed group required less frequent modifications in operative technique and a shorter operative time , there was a tendency toward a higher conversion rate ( 23 % vs. 11 % ; p = 0.174 ) and complication rate ( 29 % vs. 13 % ; p = 0.07 ) . For 38 patients with symptoms exceeding 72 hours before admission , the conversion rate remained high after delayed surgery ( 30 % vs. 17 % ; p = 0.454 ) . In addition , delayed laparoscopic cholecystectomy prolonged the total hospital stay ( 11 days vs. 6 days ; p < 0.001 ) and recuperation period ( 19 days vs. 12 days ; p < 0.001 ) . CONCLUSIONS Initial conservative treatment followed by delayed interval surgery can not reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis . Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy Background Current recommendations for treating acute calculus cholecystitis include the use of intravenous antibiotics , although these recommendations were never tested scientifically . The aim of this study was to evaluate the role of intravenous antibiotic therapy in patients with mild acute calculus cholecystitis . Methods In this prospect i ve , r and omized controlled trial , 84 patients with a diagnosis of mild acute calculus cholecystitis were r and omly assigned to supportive treatment only or supportive treatment with intravenous antibiotic treatment ( 42 patients in each arm ) . Patients were followed through their index admission and until delayed laparoscopic cholecystectomy was performed . Results The two study groups did not differ in their demographic data or in the clinical presentation and disease severity . Analysis was conducted on the intent-to-treat basis . Patients in the intravenous antibiotics arm resumed a liquid diet earlier ( 1.7 vs. 2.2 days , p = 0.02 ) but did not significantly differ in resumption of regular diet ( 2.8 vs. 3.2 days , p = 0.16 ) or hospital length of stay ( LOS ) ( 3.9 vs. 3.8 days , p = 0.89 ) . Patients in the intravenous antibiotics arm had rates of percutaneous cholecystostomy tube placement ( 12 vs. 5 % , p = 0.43 ) , readmissions ( 19 vs. 13 % , p = 0.73 ) , and perioperative course similar to those not receiving antibiotics . The overall hospital LOS , including initial hospitalization and subsequent cholecystectomy , was similar for both groups ( 5.6 vs. 5.1 days , p = 0.29 ) . Eight ( 19 % ) patients in the supportive arm were crossed over to the intravenous antibiotic arm during the index admission . Conclusions Intravenous antibiotic treatment does not improve the hospital course or early outcome in most of the patients with mild acute calculus cholecystitis The aim of this prospect i ve , r and omized study was to determine whether laparoscopic cholecystectomy should be performed as an early or a delayed operation in patients with acute cholecystitis . After diagnostic workup , patients were r and omized to one of two groups : ( 1 ) early laparoscopic cholecystectomy  ( i.e. , within 7 days after onset of symptoms ) or ( 2 ) initial conservative treatment followed by delayed laparoscopic cholecystectomy 6 to 8 weeks later .  Seventy-four patients were placed in the early-operation group , and 71 patients were assigned to the delayed-operation strategy . There was no significant difference in conversion rates ( early 31 % vs. delayed 29 % ) , operating times ( early 98 [ range 30 to 355 ] minutes vs. delayed 100 [ 45 to 280 ] minutes ) , or complications . Failure with the conservative treatment strategy was noted in 26 % of these patients . The total hospital stay was significantly shorter in the early group ( 5 [ range 3 to 63 ] days ) vs. the delayed group ( 8 [ range 4 to 50 ] days ; P < 0.05 ) . Despite a high conversion rate , early laparoscopic cholecystectomy offered significant advantages in the management of acute cholecystitis compared to a conservative strategy . The greatest advantage was a reduced total hospital stay The most common indications for emergency operative intervention in the treatment of sigmoid diverticulitis are peritonitis and failure of medical therapy .  Primary resection and diversion ( Hartmann 's procedure ) followed by delayed colostomy closure is the current st and ard of emergency surgical care . Guidelines for best operative strategy , however , remain controversial and continue to evolve based on recent comparative review s of surgical outcomes .  Primary resection and anastomosis with or without proximal diversion and laparoscopic lavage are alternatives to Hartmann 's procedure that may provide an improved outcome in properly selected patients . Ongoing changes in the historical paradigm of the surgical approach to this disease m and ate the need for large multicentered prospect i ve r and omized trials to determine the best surgical strategy under emergent conditions for the treatment of diverticulitis . The current literature is review ed with suggestions for a management algorithm Background . The role of early laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis is not yet established . The aim of our prospect i ve r and omized study was to evaluate the safety and feasibility of early LC for acute cholecystitis and to compare the results with delayed LC . Methods . Between March 2007 to December 2008 , 50 patients with diagnosis of acute cholecystitis were assigned r and omly to early group , n = 25 ( LC within 24 hrs of admission ) , and delayed group , n = 25 ( initial conservative treatment followed by delayed LC , 6–8 weeks later ) . Results . We found in our study that the conversion rate in early LC and delayed LC was 16 % and 8 % , respectively , Operation time for early LC was 69.4 min versus 66.4 min for delayed LC  , postoperative complications for early LC were 24 % versus 8 % for delayed LC  , and blood loss was 159.6 mL early group versus 146.8 mL for delayed group . However early LC had significantly shorter hospital stay ( 4.1 days versus 8.6 days ) . Conclusions . Early LC for acute cholecystitis with cholelithiasis is safe and feasible , offering the additional benefit of shorter hospital stay . It should be offered to the patients with acute cholecystitis , provided that the surgery is performed within 96 hrs of acute symptoms by an experienced surgeon Objective : Acute cholecystitis is a common disease , and laparoscopic surgery is the st and ard of care . Background : Optimal timing of surgery for acute cholecystitis remains controversial : either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics . Methods : The ACDC ( “ Acute Cholecystitis — early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy ” ) study is a r and omized , prospect i ve , open-label , parallel group trial . Patients were r and omly assigned to receive immediate surgery within 24 hours of hospital admission ( group ILC ) or initial antibiotic treatment , followed by delayed laparoscopic cholecystectomy at days 7 to 45 ( group DLC ) . For infection , all patients were treated with moxifloxacin for at least 48 hours . Primary endpoint was occurrence of predefined relevant morbidity within 75 days . Secondary endpoints were as follows : ( 1 ) 75-day morbidity using a scoring system ; ( 2 ) conversion rate ; ( 3 ) change of antibiotic therapy ; ( 4 ) mortality ; ( 5 ) costs ; and ( 6 ) length of hospital stay . Results : Morbidity rate was significantly lower in group ILC ( 304 patients ) than in group DLC ( 314 patients ): 11.8 % versus 34.4 % . Conversion rate to open surgery and mortality did not differ significantly between groups . Mean length of hospital stay ( 5.4 days vs 10.0 days ; P < 0.001 ) and total hospital costs ( & OV0556;2919 vs & OV0556;4262 ; P < 0.001 ) were significantly lower in group ILC . Conclusions : In this large , r and omized trial , laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs . Therefore , we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients . ( NCT00447304 BACKGROUND Current treatment options for acute calculous cholecystitis include either early cholecystectomy , or conservative treatment consisting of intravenous antibiotics and an interval cholecystectomy several weeks later . Percutaneous drainage is reserved for patients in whom conservative therapy failed or as a salvage procedure for high risk patients . OBJECTIVE To identify clinical and radiographic factors leading to failure of conservative treatment . METHODS We prospect ively collected data on consecutive patients admitted with the diagnosis of acute cholecystitis . Parameters were compared between patients who were successfully treated conservatively and those who required percutaneous cholecystostomy . Logistic regression analysis was performed to identify predictors for failure of conservative treatment . RESULTS The study population comprised 103 patients with a median age of 60 who were treated for acute cholecystitis . Twenty-seven patients ( 26.2 % ) required PC . On univariate analysis , age above 70 years , diabetes , elevated white blood cell count , tachycardia ( > 100 beats/min ) at admission , and a distended gallbladder ( > 5 cm transverse diameter ) were found to be significantly more common in the PC group ( P < 0.001 ) . WBC was higher in the PC group throughout the initial 48 hours . On multivariate analysis , age above 70 ( odds ratio 3.6 ) , diabetes ( OR 9.4 ) , tachycardia at admission ( OR 5.6 ) , and a distended gallbladder ( OR 8.5 ) were predictors for cholecystostomy ( P < 0.001 ) . Age above 70 ( OR 5.2 ) and WBC $ 15,000 ( OR 13.7 ) were predictors for failure of conservative treatment after 24 and 48 hours ( P < 0.001 ) . CONCLUSIONS Age above 70 , diabetes , and a distended gallbladder are predictors for failure of conservative treatment and such patients should be considered for early cholecystostomy . Persistently elevated WBC ( > 15,000 ) suggests refractory disease and should play a central role in the clinical follow-up and decision-making process for elderly patients with acute cholecystitis BACKGROUND The aim of the present study was to compare the risk of observation versus that of cholecystectomy in acute cholecystitis in patients r and omly allocated to delayed operation or conservative treatment . METHODS One-hundred- and -eighty patients were considered for participation in the study ; 71 were excluded according to predefined criteria and 45 did not join for other reasons . The remaining 64 patients were r and omized to cholecystectomy ( n = 31 ) or observation ( n = 33 ) . R and omized patients were contacted regularly and followed up for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Gallstone-related complications or emergency admissions for pain occurred in six patients in the operation group ( 19 % ; 95 % CI 5%-33 % ) and in 12 patients ( 36 % ; 9 % CI 20%-53 % ) in the observation group . Twenty-seven of 31 patients r and omized to cholecystectomy had a  cholecystectomy  at a median of 3.6 months after r and omization , and , of these , 3 ( 11 % ; 95 % CI 0%-23 % ) suffered a major and 7 ( 26 % ; 95 % CI 9%-42 % ) a minor complication . Ten patients r and omized to observation later had their gallbladders removed , 1 ( 10 % ; 95 % CI 0%-29 % ) patient had a major and 1 ( 10 % ; 95 % CI 0%-29 % ) a minor complication . We found no mortality after cholecystectomy . CONCLUSIONS We found a certain risk of subsequent gallstone-related events following conservative treatment of acute cholecystitis , but the data also show that cholecystectomy should not necessarily be compulsory after acute cholecystitis Abstract . Our objective was to compare the effectiveness of percutaneous cholecystostomy ( PC ) vs conservative treatment ( CO ) in high-risk patients with acute cholecystitis . The study was r and omized and comprised 123 high-risk patients with acute cholecystitis . All patients fulfilled the ultrasonographic criteria of acute inflammation and had an APACHE II score ≥12 .  Percutaneous cholecystostomy guided by US or CT was successful in 60 of 63 patients ( 95.2 % ) who comprised the PC group . Sixty patients were conservatively treated ( CO group ) . One patient died after unsuccessful PC ( 1.6 % ) . Resolution of symptoms occurred in 54 of 63 patients ( 86 % ) . Eleven patients ( 17.5 % ) died either of ongoing sepsis ( n=6 ) or severe underlying disease ( n=5 ) within 30 days . Seven patients ( 11 % ) were operated on because of persisting symptoms ( n=3 ) , catheter dislodgment ( n=3 ) , or unsuccessful PC ( n=1 ) . Cholecystolithotripsy was performed in 5 patients ( 8 % ) . Elective surgery was performed in 9 cases ( 14 % ) . No further treatment was needed in 32 patients ( 51 % ) . In the CO group , 52 patients ( 87 % ) fully recovered and 8 patients ( 13 % ) died of ongoing sepsis within 30 days . All successfully treated patients showed clinical improvement during the first 3 days of treatment . Percutaneous cholecystostomy in high-risk patients with acute cholecystitis did not decrease mortality in relation to conservative treatment . Percutaneous cholecystostomy might be suggested to patients not presenting clinical improvement following 3 days of conservative treatment , to critically ill intensive care unit patients , or to c and i date s for percutaneous cholecystolithotripsy Abstract Background . Cholecystectomy is routinely recommended to prevent recurrent disease after an initial episode of acute cholecystitis . Therefore , r and omized controlled trials have mainly focused on the timing of surgery , but many patients scheduled for cholecystectomy have deferred surgery with long periods of symptom-free intervals . Our present aim is to examine the long-term feasibility and safety of observation compared with surgery . Methods . Trial of 64 patients with acute cholecystitis previously r and omized to observation or cholecystectomy  , which examined outcome in terms of completed r and omized treatment and appearance of further symptoms and the need for surgical treatment .  Thirty-three patients were r and omized to observation and 31 patients to cholecystectomy .  Median follow-up was 14 years . Results . Of the 33 patients r and omized to observation , 11 ( 33 % ) experienced a new event of gallstone-related disease ( eight ( 24.2 % ) had acute cholecystitis ) and 11 ( 33 % ) were operated . No significant difference ( p = 0.565 ) was found between the two r and omized groups with regard to recurrent disease or complications . Virtually no surgery took place after 5 years of follow-up . The difference in completed r and omized treatment between the groups was not significant ( p = 0.077 ) . Long-term mortality was equal in those operated and in those observed . Conclusions . Twenty-four percent of the patients experienced recurrent cholecystitis , but escalation of disease severity or increased mortality was not observed . Long-term observation after acute cholecystitis was feasible in two-thirds of the patients as the risk for recurrent disease was negligible after 5 years BACKGROUND Percutaneous cholecystostomy ( PC ) is an alternative treatment in  acute cholecystitis ( AC ) in high-risk or elderly patients although its advantage over emergency cholecystectomy has not yet been established . STUDY DESIGN AC prospect i ve data base analysis in high-risk patients treated by PC ( group 1 , 29 patients ) or emergency cholecystectomy ( group 2 , 32 patients ) . Surgical risk was estimated by physiological POSSUM , Charlson , Apache II , and American Society of Anesthesiologists ( ASA ) scores . RESULTS The groups showed homogeneity concerning age and surgical risk . PC allowed AC resolution in 19 patients ( 70.4 % ) , but 8 ( 29.6 % ) needed emergency cholecystectomy .  Morbidity and mortality rates were 31 % and 17.2 % , respectively . Mortality was significantly associated with ASA IV ( P = .01 ) . In group 2 , the morbidity rate was 28.1 % without mortality . There was no statistical difference in morbidity ( P = .6 ) although mortality was significantly higher in group 1 ( P = .02 ) . CONCLUSIONS PC seems of little benefit and ought to be left for those very old patients with surgical contraindication BACKGROUND Emergency laparoscopic cholecystectomy has been advocated for the treatment of acute cholecystitis ; however it can be a difficult task , especially in public hospitals , with relatively high conversion and complication rates . Percutaneous cholecystostomy is a simple and effective procedure allowing patients to recover from the acute event and undergo elective laparoscopic surgery at a later stage . METHODS We prospect ively assessed a protocol of initial conservative treatment in patients admitted with acute cholecystitis . Patients who did not respond to medical treatment were treated by percutaneous cholecystostomy .  Following discharge the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary . The details of the operation were collected with emphasis on complications and conversion rate . RESULTS During a 3-year period , 224 patients who were admitted with acute calculous cholecystitis entered the protocol . Fifty-four patients did not improve under medical treatment and percutaneous cholecystostomy was performed . In spite of adequate drainage , 5 patients still did not improve : 3 patients were successfully operated upon urgently and recovered , while 2 patients who had severe concomitant diseases and multi-organ failure , died . Forty-nine patients were discharged with the catheter and later re-evaluated for elective operation . In 7 patients common bile duct stones were found and were removed by ERCP prior to the elective operation . Twenty-five patients underwent delayed laparoscopic cholecystectomy with a low conversion rate ( 8 % ) , and only minor complications ( 16 % ) . CONCLUSIONS Conservative treatment and delayed operation is still an acceptable choice in the treatment of acute cholecystitis . Percutaneous cholecystostomy is an effective tool , with high success rate and low morbidity , and allows for better pre-operative evaluation of the biliary system and safe interval laparoscopic surgery . Laparoscopic cholecystectomy after drainage of the gall bladder is a low morbidity procedure with relatively low conversion rate Treatment of acute cholecystitis is still under debate . The aim of this study was to evaluate the efficacy of early laparoscopic cholecystectomy ( ELC ) in comparison with conservative treatment followed by delayed laparoscopic cholecystectomy ( DLC ) in the management of acute cholecystitis . This prospect i ve comparative study involved two groups of patients presenting with acute cholecystitis within 72 hours of the onset of symptoms . ELC was performed in 82 consecutive patients , whereas DLC was performed in 87 patients who previously underwent medical treatment .  Surgical variables , hospital stay , and postoperative morbidity were evaluated in both groups . Time of surgery and conversion rate were lower in the ELC group . Postoperative morbidity was similar in both groups . Overall hospital stay was shorter in the ELC group . ELC within 72 hours of the onset of acute cholecystitis is a safe procedure with better results than DLC in terms of surgical timing , conversion rate , and hospital stay The aim of this prospect i ve r and omized study was to define the optimum management between early and delayed laparoscopic cholecystectomy for patients with acute cholecystitis BACKGROUND AND STUDY AIMS Surgery in elderly patients with acute cholecystitis is quite a high-risk procedure . The recent finding that activated pancreatic enzyme is present in sterile bile from the acutely inflamed gallbladder suggests that obstruction at the level of the common channel is a possible precipitating factor . It was therefore hypothesized that an initial endoscopic sphincterotomy in patients with acute cholecystitis might improve the clinical course . PATIENTS AND METHODS A prospect i ve unselected series of 105 patients over 65 years of age ( 52 men , 53 women ; mean age 78 ) suffering from acute cholecystitis were initially treated on a r and om basis with either conservative methods or endoscopic sphincterotomy . Within the first 72 h after the onset of symptoms , all 52 patients in the endoscopic sphincterotomy group were managed by endoscopic retro grade cholangiopancreatography ( ERCP ) , combined with endoscopic sphincterotomy in 50 cases . The main study parameter was the need for emergency cholecystectomy  within the first week after admission . RESULTS Biliary sepsis requiring emergency surgery occurred in 15 patients in the conservatively treated group , in contrast with none of the 52 patients in the endoscopic sphincterotomy group ( P < 0.001 ) . Iatrogenic complications after endoscopic sphincterotomy  occurred in three patients , one of whom required surgery , while two were managed by conservative means . The clinical course improved , avoiding the need for emergency cholecystectomy and other interventions , in 48 patients in the endoscopic sphincterotomy group and in 36 patients in the conservatively treated group ( P < 0.01 ) . CONCLUSIONS The clinical course after endoscopic sphincterotomy  improved in the majority of elderly patients suffering from acute cholecystitis , suggesting that early relief of obstruction at the level of the common channel reduces the risk of developing biliary sepsis . The majority of these patients can undergo surgery electively or can receive further conservative treatment BACKGROUND Patients with acute cholecystitis are treated in Hospital . The aim of the study was to analyze the security and efficacy of treating not-operated-on patients with acute cholecystitis in Hospital in the Home ( HIH ) . METHODS Prospect i ve study from January 2010 to May 2011 including all patients diagnosed with acute cholecystitis , not operated on and without comorbidities admitted to HIH Unit from the Emergency Department Short Stay Unit and Observation Unit . Patients were treated with ertapenem for at least one week . Intravenous treatment was followed by oral therapy to complete 14 days of antibiotic treatment . Patient characteristics , clinical course , need for return to hospital during admission to HIH , and admission to hospital in the month after discharge from HIH are analyzed . RESULTS 25 patients were included . Mean age was 59 years ( 34 - 82 ) . Upon arrival to the Emergency Department , all patients suffered abdominal pain , 60 % had fever , and 32 % vomiting . 48 % of patients had a leukocyte count over 13,000 cells/μl . All patients had cholelithiasis and a distended gallbladder . 56 % showed thickening of the gallbladder wall . Fluid accumulation around the gallbladder was noted in 16 % of the cases . Murphy 's sign proved positive in 44 % . All patients showed a favorable course . No patient required hospital readmission during stay in HIH or in the month after discharge . All patients expressed their satisfaction with treatment at home . CONCLUSIONS Patients with acute cholecystitis and without comorbidities can be safely and effectively treated in HIH after a short monitoring period in hospital
target: Discussion Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe , especially in patients with mild disease .
background: Background In medical practice , the tendency to remove an inflamed gallbladder is deeply rooted .
  Cholecystectomy , however , is associated with relatively high complication rates , and therefore the decision whether or not to perform surgery should be well considered .
  For some patients , the surgical risk – benefit profile may favour conservative treatment .
  The objective of this study was to examine the short- and long-term outcome of conservative treatment of patients with acute calculous cholecystitis .