2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystit
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(2020) 15:61
REVIEW
Open Access
2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis Michele Pisano1* , Niccolò Allievi1, Kurinchi Gurusamy2, Giuseppe Borzellino3, Stefania Cimbanassi4, Djamila Boerna5, Federico Coccolini6, Andrea Tufo7, Marcello Di Martino8, Jeffrey Leung2, Massimo Sartelli9, Marco Ceresoli10, Ronald V. Maier11, Elia Poiasina1, Nicola De Angelis12, Stefano Magnone1, Paola Fugazzola13, Ciro Paolillo14, Raul Coimbra15, Salomone Di Saverio16, Belinda De Simone17, Dieter G. Weber18, Boris E. Sakakushev19, Alessandro Lucianetti1, Andrew W. Kirkpatrick20, Gustavo P. Fraga21, Imitaz Wani22, Walter L. Biffl23, Osvaldo Chiara4, Fikri Abu-Zidan24, Ernest E. Moore25, Ari Leppäniemi26, Yoram Kluger27, Fausto Catena28 and Luca Ansaloni13
Abstract Background: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. Materials and methods: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www. gradeworkinggroup.org/). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. Results: The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. (Continued on next page)
* Correspondence: [email protected] 1 General Surgery I, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, shar
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