The value of early surgery and routine operative cholangiography in the management of acute cholecystitis

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Abstract
Acute cholecystitis remains one of the most frequent abdominal emergencies, and yet many aspects of its management remain controversial. This prospective study of 182 consecutive operations for acute cholecystitis was conceived to assess the value of early surgery and routine operative cholangiography in the improvement of both immediate and long‐term results.The patients ranged from 26 to 82 years of age, with about 1/3 of them above 60 years. Gangrenous changes were encountered in 21% of patients, and perforated cholecystitis occurred in 2%. No biliary calculi were found in 6%. Cholecystectomy was performed in all patients. A technically successful operative cholangiography via the cystic duct was performed in 94% of patients. No complications due to cholangiography were encountered, and the procedure was 93% accurate (11 false positives, 0 false negatives). The common bile duct was explored in 48 patients (26%) and found to be diseased in 75% of them. There was one postoperative death (0.5%), caused by sepsis and gastrointestinal bleeding. Clinical and x‐ray follow‐up, ranging from 2–6 years, disclosed 4 residual stones (2%). We conclude that a therapeutic policy combining early surgery with routine operative cholangiography improves results and decreases the incidence of residual ductal abnormalities.

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