Invited Critique |

Evolving Treatment Paradigms for Acute Cholecystitis:  Comment on “Surgical Management of Acute Cholecystitis at a Tertiary Care Center in the Modern Era”

John P. Welch, MD
Arch Surg. 2010;145(5):444. doi:10.1001/archsurg.2010.53.
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Over the past 2 decades, laparoscopy has revolutionized the surgical management of AC. Within the limits of a retrospective study, this review of 809 patients documents the progressive use of LC and the gradual abandonment of OC at a tertiary medical center.

In most cases of AC, the critical operative anatomy can be demonstrated, despite inflammatory changes. The authors confirm that LC can be completed by most (as opposed to selected) general surgeons with minimal risk of bile duct injury. Operative cholangiography is usually unnecessary when the anatomy is clear. Cholangiography was used liberally in this study; the actual indications such as elevated liver function test results are not discussed. We usually perform endoscopic retrograde cholangiopancreatography before surgery if choledocholithiasis is suspected.

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