Acute Cholecystitis
Topic overview
Two experienced surgeons discuss the clinical and operative management of acute cholecystitis, covering patient selection, cholecystostomy tube management, and surgical techniques for both simple and complex cases. The conversation addresses intraoperative challenges, cholangiography indications, and approaches to difficult dissections in inflamed gallbladders.
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Key takeaways
- Cholecystostomy tube placement provides temporizing drainage for high-risk patients unfit for immediate cholecystectomy.
- Intraoperative cholangiography helps identify bile duct anatomy and common duct stones during acute cholecystitis cases.
- Transcystic antegrade sphincteroplasty offers alternative for common duct stone management when ERCP unavailable or failed.
- Difficult dissections in acute cholecystitis require strategic approach: fundus-down technique or subtotal cholecystectomy when safe.
- Timing of interval cholecystectomy after tube placement balances inflammation resolution with patient fitness for surgery.
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