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28-12-2023 | Cholecystectomy | Consensus Conference

Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines

Authors: Federico Coccolini, Eugenio Cucinotta, Andrea Mingoli, Mauro Zago, Gaia Altieri, Alan Biloslavo, Roberto Caronna, Ismail Cengeli, Enrico Cicuttin, Roberto Cirocchi, Luigi Cobuccio, Gianluca Costa, Valerio Cozza, Camilla Cremonini, Giovanni Del Vecchio, Giuseppe Dinatale, Valeria Fico, Christian Galatioto, Hayato Kuriara, Domenico Lacavalla, Antonio La Greca, Alberto Larghi, Diego Mariani, Paolo Mirco, Savino Occhionorelli, Dario Parini, Francesco Polistina, Mihai Rimbas, Paolo Sapienza, Dario Tartaglia, Giuseppe Tropeano, Piero Venezia, Dario Francesco Venezia, Claudia Zaghi, Massimo Chiarugi

Published in: Updates in Surgery | Issue 2/2024

Abstract

Dealing with acute cholecystitis in high-risk, critically ill, and unfit-for-surgery patients is frequent during daily practice and requires complex management. Several procedures exist to postpone and/or prevent surgical intervention in those patients who temporarily or definitively cannot undergo surgery. After a systematic review of the literature, an expert panel from the Italian Society of Emergency Surgery and Trauma (SICUT) discussed the different issues and statements in subsequent rounds. The final version of the statements was discussed during the annual meeting in Rome (September 2022). The present paper presents the definitive conclusions of the discussion. Fifteen statements based on the literature evidence were provided. The statements gave precise indications regarding the decisional process and the management of patients who cannot temporarily or definitively undergo cholecystectomy for acute cholecystitis. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients should be multidisciplinary. The different gallbladder drainage methods must be tailored according to each patient and based on the expertise of the hospital. Percutaneous gallbladder drainage is recommended as the first choice as a bridge to surgery or in severely physiologically deranged patients. Endoscopic gallbladder drainage (cholecystoduodenostomy and cholecystogastrostomy) is suggested as a second-line alternative especially as a definitive procedure for those patients not amenable to surgical management. Trans-papillary gallbladder drainage is the last option to be reserved only to those unfit for other techniques. Delayed laparoscopic cholecystectomy in patients with percutaneous gallbladder drainage is suggested in all those patients recovering from the conditions that previously discouraged surgical intervention after at least 6 weeks from the gallbladder drainage.

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Title: Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines
Authors: Federico Coccolini
Eugenio Cucinotta
Andrea Mingoli
Mauro Zago
Gaia Altieri
Alan Biloslavo
Roberto Caronna
Ismail Cengeli
Enrico Cicuttin
Roberto Cirocchi
Luigi Cobuccio
Gianluca Costa
Valerio Cozza
Camilla Cremonini
Giovanni Del Vecchio
Giuseppe Dinatale
Valeria Fico
Christian Galatioto
Hayato Kuriara
Domenico Lacavalla
Antonio La Greca
Alberto Larghi
Diego Mariani
Paolo Mirco
Savino Occhionorelli
Dario Parini
Francesco Polistina
Mihai Rimbas
Paolo Sapienza
Dario Tartaglia
Giuseppe Tropeano
Piero Venezia
Dario Francesco Venezia
Claudia Zaghi
Massimo Chiarugi
Publication date: 28-12-2023
Publisher: Springer International Publishing
Keywords: Cholecystectomy
Cholecystitis
Septic Shock
Published in: Updates in Surgery / Issue 2/2024
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-023-01729-8

At a glance: The STEP trials

Springer Medicine

Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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