What a difference a year makes: Long-term follow-up of non-operative management in acute cholecystitis

ABSTRACT

Aim: Surgery is currently The recommended treatment for acute cholecystitis and The Association of Upper Gastrointestinal Surgeons (AUGIS) recommends that laparoscopic cholecystectomy be performed within 72 hours of admission. However, given The impact of The COVID-19 pandemic on healthcare delivery, this is not always possible. So, what happens to those who are managed conservatively? We observed The long-term impact of conservative management of patients admitted with acute cholecystitis over The course of one year. Method(s) Twenty-eight patients were admitted with acute cholecystitis to a large tertiary hospital in November 2020;twenty-three were discharged without having had a cholecystectomy. These patients were followed up for one year and observed for The development of any gallstone-related admissions and Surgical procedures. Result(s) of The 23 patients observed, 30% (n=7) were admitted for gallstone-related complications. Biliary colic was responsible for 43% of these admissions with pancreatitis (14%), cholangitis (14%), choledocholithiasis (14%), and cholecystitis (14%) causing The reSt. only 9% (n=2) received a laparoscopic cholecystectomy. In both cases, it was in an Emergency setting during admission for Biliary colic. Conclusion(s) Long-term observation of conservatively managed acute cholecystitis was possible in around two-thirds of patients as no gallstone-related hospital admissions were observed. Biliary colic was The most common cause of gallstone-related admissions. Longer observation is required to assess The feasibility of long-term non-operative management in acute cholecystitis.