Current Management of Complicated Acute Cholecystitis: A Literature Review of Surgical and Minimally Invasive Strategies
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Published in Vol. 1 No. 1 (2026) of Loja Medical Journal.
About the JournalAbstract
Introduction: Complicated acute cholecystitis represents a spectrum of inflammatory and infectious disease of the gallbladder that includes gangrenous, emphysematous, perforated, empyematous, acalculous forms, as well as cases associated with abscesses, biliary peritonitis, or sepsis. Its management requires timely diagnosis, severity stratification, rational antibiotic therapy, and early source control. Objective: To synthesize the evidence published between 2021 and 2026 on the contemporary management of complicated acute cholecystitis, with emphasis on surgical and minimally invasive strategies. Methods: A narrative literature review was conducted using articles indexed in PubMed/MEDLINE, PMC, JAMA Network, EClinicalMedicine, SpringerLink, and ScienceDirect, prioritizing systematic reviews, meta-analyses, international consensus statements, recent clinical guidelines, and high-impact narrative review. Results: Early laparoscopic cholecystectomy during the index admission remains the treatment of choice in patients with sufficient physiological reserve. In cases of a difficult gallbladder, bailout strategies, particularly subtotal cholecystectomy, reduce the risk of bile duct injury when achieving the critical view of safety is not possible. In patients at high surgical risk, percutaneous cholecystostomy continues to play a relevant role as a bridge to definitive treatment or as selected definitive therapy; however, recent evidence favors cholecystectomy when the patient can tolerate it. Endoscopic ultrasound-guided gallbladder drainage is emerging as an effective alternative in centers with advanced expertise. Conclusions: Current management should be individualized through a multidisciplinary approach that integrates clinical severity, anesthetic risk, biliary anatomy, technological availability, and team expertise. The therapeutic priority is source control with the lowest possible morbidity.
References
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