Controversias en el manejo de la colecistitis aguda tardía

Acute cholecystitis is the inflammation of the gallbladder, in most cases explained by the presence of mixed or cholesterol stones that produce obstruction, which triggers various inflammatory factors.  Laparoscopic cholecystectomy performed within 72 hours of the onset of symptoms became the gold standard management of the acute process. The controversy is set on the management after 72 hours from the onset of symptoms, a condition called late acute cholecystitis, at which time the inflammatory process is already in place making the procedure technically more complex and dangerous. For this condition, two management strategies have been defined; one consists of early surgery (during index hospitalization) while the second is initial conservative antibiotic treatment for the assumed complete resolution of the inflammation (cooling off the process), followed by a laparoscopic cholecystectomy several weeks later (deferred, elective). There is abundant literature exposing the benefits and probable complications for both strategies, but currently the optimal moment to practice the surgical intervention is still being debated. The most recent works show some benefits in favor of early surgery, although intraoperative complications occur in the same proportions, surgery in the same hospitalization reduces costs, readmissions, and hospital times. The objective of this article, after reviewing the literature available for and against, is to recommend the procedure early, even when more than three days of symptoms have passed, and defer surgery only in very selected cases.