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

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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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Authors and Affiliations

  1. General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy

    Federico Coccolini, Ismail Cengeli, Enrico Cicuttin, Luigi Cobuccio, Camilla Cremonini, Dario Tartaglia & Massimo Chiarugi

  2. General Surgery Department, Messina University Hospital, Messina, Italy

    Eugenio Cucinotta & Roberto Caronna

  3. Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy

    Andrea Mingoli & Paolo Sapienza

  4. General Surgery Department, Lecco Hospital, Lecco, Italy

    Mauro Zago

  5. Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Gaia Altieri, Valerio Cozza, Valeria Fico, Antonio La Greca, Alberto Larghi, Paolo Mirco & Giuseppe Tropeano

  6. General Surgery Department, Trieste University Hospital, Trieste, Italy

    Alan Biloslavo

  7. General Surgery Department, Perugia University Hospital, Perugia, Italy

    Roberto Cirocchi

  8. General Surgery Department, Campus Biomedico University Hospital, Rome, Italy

    Gianluca Costa

  9. General Surgery Department, San Carlo Hospital, Potenza, Italy

    Giovanni Del Vecchio & Giuseppe Dinatale

  10. General Surgery Department, Livorno Hospital, Leghorn, Italy

    Christian Galatioto

  11. Emergency Surgery Department, Policlinico Hospital, Milan, Italy

    Hayato Kuriara

  12. Emergency Surgery Department, Ferrara University Hospital, Ferrara, Italy

    Domenico Lacavalla & Savino Occhionorelli

  13. General Surgery Department, Legnano Hospital, Legnano, Italy

    Diego Mariani

  14. General Surgery Department, Rovigo Hospital, Rovigo, Italy

    Dario Parini

  15. General Surgery Department, Madre Teresa di Calcutta Hospital, Padua, Italy

    Francesco Polistina

  16. Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

    Mihai Rimbas

  17. Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

    Mihai Rimbas

  18. General Surgery Department, Bari University Hospital, Bari, Italy

    Piero Venezia & Dario Francesco Venezia

  19. General Surgery Department, Vicenza Hospital, Vicenza, Italy

    Claudia Zaghi

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  1. Federico Coccolini
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Contributions

FC performed manuscript conception and draft. All authors critically revised the manuscript and contributed to important scientific knowledge, giving the final approval.

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Correspondence to Federico Coccolini.

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Coccolini, F., Cucinotta, E., Mingoli, A. et al. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines. Updates Surg 76, 331–343 (2024). https://doi.org/10.1007/s13304-023-01729-8

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