Early versus delayed cholecystectomy for acute cholecystitis.

The controversy between early or delayed cholecystectomy continues, although recent opinion appears to favour the early approach. If this policy of early operation is to be adopted then an accurate diagnosis must be obtained at the earliest opportunity. An accurate diagnosis of acute cholecystitis is made from a careful history, the relevent clinical findings and if possible a HIDA scan demonstrating non-filling of the gallbladder. However, if radionucleotide scanning is not available then real-time ultrasonography is the next best choice, but must be interpreted with care as it is not as specific as the HIDA scan. The advantages of removing the disease process at one hospital admission are considerable, and result in a substantial saving of days spent in hospital, without the problem of patients developing recurrent symptoms while waiting for a delayed cholecystectomy. The operation is occasionally technically demanding, but this can equally well be the case when a delayed cholecystectomy is performed. If the surgeon finds that the acute inflammation is so severe that structures around Calot's triangle cannot be safely dissected then the surgeon must be prepared to retreat and perform a cholecystostomy (Skillings et al, 1980). If the delayed approach is followed, then the patient must be re-examined at regular intervals.(ABSTRACT TRUNCATED AT 250 WORDS)