Common Surgical Treatments for Acute Cholecystitis

Acute cholecystitis, often caused by gallstones or gallbladder polyps, leads to sudden inflammation of the gallbladder. Patients typically experience tenderness and rebound pain in the right upper quadrant of the abdomen, with a positive Murphy's sign. Elevated white blood cell counts and fever, often reaching 38–39°C, are common symptoms. In such cases, emergency surgery is usually required to remove the inflamed gallbladder.

The preferred method for treating acute cholecystitis is laparoscopic cholecystectomy, a minimally invasive procedure that offers faster recovery and fewer complications. During this surgery, small incisions are made in the abdomen to insert a laparoscope and surgical instruments. Carbon dioxide is used to inflate the abdominal cavity, allowing the surgeon better visibility. Using a three-port technique, the cystic duct and artery are carefully ligated and divided before the gallbladder is removed.

However, in some cases, if the inflammation persists for several days and laparoscopic removal is not feasible due to severe adhesions or extensive infection, an open cholecystectomy may be necessary. This traditional approach involves a larger abdominal incision and typically results in a longer recovery period. It also carries a higher risk of complications such as gallbladder gangrene or perforation.

For critically ill patients with unstable vital signs, including fluctuating temperature and blood pressure, an emergency cholecystostomy may be performed. This involves making an incision at the bottom of the gallbladder and inserting a T-tube for drainage. This temporary measure helps stabilize the patient, with definitive surgery—removal of the gallbladder—usually scheduled about three months later.