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 .
Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial
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
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 .