After an acute attack of cholecystitis which is an early suitable period for cholecystectomy:
a. After the diagnosis of acute cholecystitis is made, IV fluids, antibiotics, and analgesia should be initiated.
b. Antibiotics should cover gram-negative aerobes as well as anaerobes. More than half of patients with acute cholecystitis have positive cultures from the gallbladder bile. Because it is difficult to know who is secondarily infected, IV antibiotics are an appropriate part of the management.
c. Cholecystectomy is the definitive treatment for patients with acute cholecystitis.
d. Early cholecystectomy performed within 2 to 3 days of presentation is preferred over interval or delayed cholecystectomy that is performed 6 to 10 weeks after initial medical therapy.
e. About 20% of patients fail initial medical therapy and require surgery during the initial admission or before the end of the planned cooling-off period.
f. Laparoscopic cholecystectomy is the preferred approach to patients with acute cholecystitis.
g. Conversion to an open procedure should be made if the inflammation prevents adequate visualization of important structures.
h. The conversion rate to an open cholecystectomy is higher (4%-35%) in the setting of acute cholecystitis than with chronic cholecystitis.
i. Early laparoscopic cholecystectomy, due to a reduced length of hospital stay and readmissions, is a more cost-effective approach than open cholecystectomy for acute cholecystitis.