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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

Early cholecystectomy between 48–72 hours of an admission for acute cholecystitis is advised, except if contraindicated by the patient’s condition, comorbidities, duration of symptoms, or findings on imaging.

If a patient is discharged from hospital without surgery after an episode of acute cholecystitis or pancreatitis, an interval cholecystectomy may be indicated, although there are increased risks associated with delayed surgery.

When is the procedure indicated?

If the patient’s condition contraindicates a cholecystectomy, an interval cholecystectomy will need to be arranged.  

Best care recommendations

Early cholecystectomy between 48–72 hours of admission for acute cholecystitis is considered best care.

A cholecystectomy can be performed for gall stone pancreatitis during the same admission after the patient’s symptoms have settled, except where the pancreatitis or its complications persist.

While an early cholecystectomy is ideal for the majority of patients, where this is not possible, a cholecystectomy will usually be scheduled some weeks after discharge.

Health services need to monitor their rates of acute and interval cholecystectomy, including the timeliness of surgery.

Evidence

Ackerman, J, Abegglen, R, Scaife, M, Peitzman, A, Rosengart, M, Marsh W, et al. Beware of the interval cholecystectomy. Journal of Trauma and Acute Care Surgery. 2017; 83(1): 55-60. [cited 2020 Jun 24]. 

Cao AM, Eslick GD, Cox MR. Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case–control studies. Surgical Endoscopy. 2016 Mar 1;30(3):1172-82. [cited 2020 Jun 24]. 

Dimou FM, Adhikari D, Mehta HB, Riall TS. Trends in follow-up of patients presenting to the emergency department with symptomatic cholelithiasis. Journal of the American College of Surgeons. 2016;222(4):377-84. 

El Zanati H, Nassar AH, Zino S, Katbeh T, Ng HJ, Abdellatif A. Gall bladder empyema: early cholecystectomy during the index admission improves outcomes. JSLS: Journal of the Society of Laparoscopic & Robotic Surgeons. 2020 Apr;24(2). [cited 2020 Jun 24].

Gurusamy KS, Koti R, Fusai G, Davidson BR. Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic. Cochrane Database of Systematic Reviews. 2013(6). [cited 2020 Jun 24]. 

Lyu Y, Cheng Y, Wang B, Zhao S, Chen L. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: an up-to-date meta-analysis of randomized controlled trials. Surgical Endoscopy. 2018 Dec 1;32(12):4728-41. [cited 2020 Jun 24].

Menahem B, Mulliri A, Fohlen A, Guittet L, Alves A, Lubrano J. Delayed laparoscopic cholecystectomy increases the total hospital stay compared to an early laparoscopic cholecystectomy after acute cholecystitis: an updated meta-analysis of randomized controlled trials. HPB: The Official Journal of the International Hepato Pancreato Biliary Association. 2015 Oct 1;17(10):857-62. [cited 2020 Jun 24]. 

Page last updated: 23 Dec 2020

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