Discussion Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe , especially in patients with mild disease .
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 .
Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy?
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
Discussion Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe , especially in patients with mild disease .
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 .