The basis of treating cholecystitis (infection of the gallbladder) is to remove the infection and if possible remove the gallbladder which can cause ongoing or recurrent infection.
The treatment choices are:
- removal of the infected gallbladder with an operation soon
- treatment with antibiotics, then later removal of the gallbladder after at least 6 weeks when the infection and resultant stickiness of gallbladder has settled down
- treatment with antibiotics and with a drainage tube through the sin into the gallbladder (either avoiding or delaying an operation).
The important factors in helping to decide which is the correct treatment in a particular situation are:
- fitness of the patient for anaesthetic and surgery (i.e. what other medical conditions does the patient have that might make anaesthetic dangerous)
- time the infection has been present / how long the symptoms have been going for (if the infection has been present for a while the gallbladder becomes very difficult to remove in an early operation)
- if there is an abscess into the liver associated with the infection (difficult for operation, drainage is better first)
- if not for early surgery, depends whether antibiotics adequately treat the initial infection on their own
- availability of surgical expertise and hospital staff and infrastructure to perform an emergency operation
- patient and surgeon preference (noting that an earlier operation during the time of the initial infection has a little higher risk that the operation can't be done laparoscopically (by keyhole) and may need a laparotomy (bigger cut))
GENERALLY, the preference is to try and remove the infected gallbladder early on (i.e. during the initial admission to hospital), to treat the infection and remove the source of infection so it can't occur again. If there are reasons against doing the operation early, the second choice would be to give antibiotics, then remove the gallbladder after 6 weeks. If it is too dangerous for the patient to undergo surgery and/or the infection is not resolving or related to abscess, then a drain into the gallbladder may be required.
Each patient's situation and condition is different so needs an individualised assessment by a qualified surgeon.
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