Early surgery best for gallbladder inflammation

NEW YORK (Reuters Health) - In patients who develop acute inflammation of the gallbladder, its best to have the gallbladder removed using minimally invasive surgery within 24 hours of hospital admission, rather than waiting weeks to years after a course of antibiotics has been given, new research shows.

Early gallbladder removal using laparoscopic or "key-hole" surgery reduces time spent in the hospital without increasing the risk of complications, Dr. Robert A. Casillas and colleagues, from Kaiser Permanente Los Angeles Medical Center, found.

The gallbladder is a pear-shaped, muscular sac attached to the undersurface of the right lobe of the liver, whose function in the body is to store and concentrate bile and aid in the digestive process. Cholecystitis is often caused by gallstones in the gallbladder and less commonly by trauma.

Casillas and colleagues reviewed the records of 173 patients with acutely inflamed gallbladders (also called cholecystitis). In 71 patients (41 percent), early laparoscopic gallbladder removal, or "cholecystectomy" was performed. Of the remaining 102 patients (59 percent) who were treated with antibiotics alone, 57 were successfully treated and 45 were not.

Twenty-six of the patients who failed antibiotic therapy underwent late laparoscopic cholecystectomy and 19 underwent a procedure called cholecystostomy in which an opening through the abdominal wall into the gallbladder is made, usually to drain off fluid.

Ultimately, 55 patients underwent "interval" laparoscopic cholecystectomy, defined as gallbladder removal 2 weeks to 2 years after successful treatment with antibiotics alone or with cholecystostomy.

Compared with the interval procedure, early gallbladder removal was associated with a significant reduction in time spent in the hospital. Moreover, the early operation did not increase complications.

Despite the advantages seen with early gallbladder removal, it is not the most common treatment for acute gallbladder inflammation, Casillas and colleagues note. They urge doctors "worldwide to adopt a consistent policy of early laparoscopic cholecystectomy unless specifically contraindicated."

SOURCE: Archives of Surgery, June 2008.