2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis
WSES · 2020 · international
Source and licence
- Authors
- Michele Pisano, Niccolò Allievi, Kurinchi Gurusamy et al.
- Title
- 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis
- Journal
- World Journal of Emergency Surgery : WJES, 2020
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC7643471
Licence statement of the original publication
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Recommendations
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Section 3. Surgical treatment of ACC
- A reaffirmation of the safety of laparoscopic cholecystectomy for ACC was shown in another systematic review comparing early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC), including seven discordant meta-analyses and systematic reviews published from 2004 to 2015. The conclusions were that no differences in mortality, bile duct injury, bile leakage, overall complications and conversion to open surgery were seen. However, ELC had a significant reduction in wound infection, hospitalisation, duration of surgery and quality of life [76].
Abstract
Background: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC.
Materials and methods: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached.
Results: The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal.
Conclusions, knowledge gaps and research recommendations: ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
Contents of the original publication
The section headings of the original.
- Background
- Materials and methods
- Section 1. Diagnosis of ACC
- Section 2. Associated common bile duct stones: which tools to use for suspicion and diagnosis at presentation?
- Section 3. Surgical treatment of ACC
- Patients with liver cirrhosis
- Patients over 80 years old
- Patients who are pregnant
- Section 4. Timing of cholecystectomy in people with ACC
- Section 5. Risk prediction in ACC
- Section 6. Alternative treatment for patients with ACC who are not suitable for surgery: observation and techniques for gallbladder drainage
- Section 7. Antibiotic treatment of ACC
- Conclusions, knowledge gaps and research recommendations
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