A Single Cohort Study of Acute Cholecystitis Managed Conservatively

Background: Cholelithiasis is less common in South Indians. Cholecystectomy is the treatment of choice for cholelithiasis and acute cholecystitis. However, conservative therapy is also an alternative option for many patients. This work aimed to estimate the rate of recurrence of the disease in patients diagnosed with uncomplicated cholecystitis who were managed conservatively analyse the outcome of conservative management protocol and estimate the proportion of patients who needed follow-up laparoscopic cholecystectomy due to recurrence. Materials and Methods: It is a single cohort study by collecting data from conservatively managed uncomplicated cholecystitis patients and doing follow-up studies on them, for 1 year from the day of diagnosis at the Department of General Surgery in Medical College Hospital, Thrissur. After applying inclusion and exclusion criteria a total of 207 patients were included in the study. Data were obtained by the investigator from patient interviews with the help of a verified pro forma, together with patient medical records. The patient was followed up during follow-up reviews and repeated admissions, and those who did not turn up with recurrence were contacted through telephonic interviews and data were collected. Data are presented as numbers or percentages and analysed with the help of a statistician. Independent variables were assessed by the Chi-square test. Results: The recurrence rate of acute cholecystitis symptoms in patients with uncomplicated cholecystitis who were conservatively managed was 19.4% and the rate of emergency cholecystectomy was 7.3%. The majority of recurrences occurred during the initial 3 months of the follow-up period of 1 year. Signs of jaundice, right hypochondrial mass, leucocytosis of >18,000, ultrasound finding of gall bladder wall oedema and pericholecystic collection were found to be significant factors affecting recurrence. Of the 190 patients who were being followed up only 78 had undergone elective/emergency cholecystectomy which shows that the remaining 112 patients are symptom-free after conservative treatment. The majority of conservatively managed patients were asymptomatic at the end of 6 months of follow-up, showing that an option of interval cholecystectomy is not always necessary in a conservatively managed patient. Conclusion: We conclude that interval cholecystectomy is not always necessary in a conservatively managed patient.