2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis
Open accessAbstract
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. Conclusions, knowledge gaps and research recommendations: ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
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All guidelines recommended physical examinations as an essential part of the diagnostic process, preferably as the first action.
“All guidelines recommended physical examinations as an essential part of the diagnostic process, preferably as the first action.”
From Evaluation and mitigation of the limitations of large language models in clinical decision-making (2024) · cites this paper as [37]
Section 1, Diagnosis of ACC (page not provided), suggests including a complete clinical examination alongside history, laboratory tests and imaging. It does not say examination should be the first action, and this single guideline does not establish what all guidelines recommend. (LLM, conf=0.87)
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Added value of point shear-wave elastography in the diagnosis of acute cholecystitis
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Evaluation and mitigation of the limitations of large language models in clinical decision-making
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2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy
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Self-citationWSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections
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Self-citationInnovative Approaches to Safe Surgery: A Narrative Synthesis of Best Practices
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The development and evaluation of nine obesity-based indices for gallstones in U.S. adults
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Self-citationLuo, D., Chen, X., Dai, Y., Kuang, F. L., Kang, M., Li, B., & Su, S. (2023) · International Journal of Surgery · doi:10.1097/js9.0000000000000332 · Cited by 24 · see citing works
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Clinical practice selectively follows acute appendicitis guidelines
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Klein, J. R., Lemma, M., Prabhakaran, K., Rafieezadeh, A., Kirsch, J. M., Rodriguez, G., Blazar, I., Jose, A. M., & Zangbar, B. (2024) · Trauma Surgery & Acute Care Open · doi:10.1136/tsaco-2024-001522 · Cited by 22 · see citing works
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Coelho, J. C. U., da Costa, M. A. R., Enne, M., Torres, O. J. M., Andraus, W., & Campos, A. C. L. (2023) · ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) · doi:10.1590/0102-672020230031e1749 · Cited by 20 · see citing works
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Self-citationAssociations of cholecystectomy with the risk of colorectal cancer: a Mendelian randomization study
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Robotic versus laparoscopic general surgery in the emergency setting: a systematic review
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Improving Diagnosis of Acute Cholecystitis with US: New Paradigms
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Association Between Trimester and Outcomes after Cholecystectomy During Pregnancy
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Percutaneous cholecystostomy: techniques and applications
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Self-citationThe i-EUS consensus on EUS-guided gallbladder drainage: A 3-step modified Delphi approach
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Self-citationUpdates on Antibiotic Regimens in Acute Cholecystitis
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Multiple logistic regression model to predict bile leak associated with subtotal cholecystectomy
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Self-citationRamia, J. M., Serradilla-Martín, M., Villodre, C., Rubio, J. J., Rotellar, F., Siriwardena, A. K., Wakabayashi, G., Catena, F., PERCHODEL Collaborative Study Group, Abe, T., et al. (2024) · World Journal of Emergency Surgery · doi:10.1186/s13017-024-00561-8 · Cited by 13 · see citing works
Self-citationBarie, P. S., Kao, L. S., Moody, M., & Sawyer, R. G. (2023) · Surgical Infections · doi:10.1089/sur.2022.363 · Cited by 13 · see citing works
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Cholecystectomy in patients with cirrhosis: a population-based cohort study from England
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Management of Gallstone Disease
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- Authors
- Pisano, M., Allievi, N., Gurusamy, K., Borzellino, G., Cimbanassi, S., Boerna, D., Coccolini, F., Tufo, A., Di Martino, M., Leung, J., Sartelli, M., Ceresoli, M., Maier, R. V., Poiasina, E., De Angelis, N., Magnone, S., Fugazzola, P., Paolillo, C., Coimbra, R., Di Saverio, S., De Simone, B., Weber, D. G., Sakakushev, B. E., Lucianetti, A., Kirkpatrick, A. W., Fraga, G. P., Wani, I., Biffl, W. L., Chiara, O., Abu-Zidan, F., Moore, E. E., Leppäniemi, A., Kluger, Y., Catena, F., & Ansaloni, L.
- Affiliations
- Ospedale Papa Giovanni XXIII (IT)
- University College London (GB)
- University of Verona (IT)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- St. Antonius Ziekenhuis (NL)
- University of Pisa (IT)
- The Royal Free Hospital (GB)
- University of Macerata (IT)
- University of Milano-Bicocca (IT)
- University of Washington (US)
- Ospedale “M. Bufalini” di Cesena (IT)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Riverside University Health System - Medical Center (US)
- The University of Western Australia (AU)
- Plovdiv University (BG)
- Foothills Medical Centre (CA)
- Universidade Estadual de Campinas (UNICAMP) (BR)
- Sher-i-Kashmir Institute of Medical Sciences (IN)
- Scripps Memorial Hospital (US)
- Denver Health Medical Center (US)
- Helsinki University Hospital (FI)
- Rambam Health Care Campus (IL)
- University of Parma (IT)
- Corresponding author
- Pisano, Michele
- ORCID
- Pisano, Michele
- Allievi, Niccolò
- Gurusamy, Kurinchi
- Borzellino, Giuseppe
- Cimbanassi, Stefania
- Coccolini, Federico
- Tufo, Andrea
- Leung, Jeffrey
- Sartelli, Massimo
- Ceresoli, Marco
- Maier, Ronald V.
- Magnone, Stefano
- Fugazzola, Paola
- Paolillo, Ciro
- Coimbra, Raul
- Weber, Dieter G.
- Sakakushev, Boris E.
- Lucianetti, Alessandro
- Kirkpatrick, Andrew W.
- Fraga, Gustavo P.
- Biffl, Walter L.
- Chiara, Osvaldo
- Moore, Ernest E.
- Leppäniemi, Ari
- Kluger, Yoram
- Catena, Fausto
- Ansaloni, Luca
- Venue
- World Journal of Emergency Surgery
- Published
- 2020-11-05
- Volume
- 15
- Issue
- 1
- Pages
- 61-61
- ISSN
- 1749-7922 (ISSN-L)
- PMC
- PMC7643471
- OpenAlex
- W3096406900
- Cited by
- 581
- References
- 183
- Citations by year
- 2026: 110 · 2025: 138 · 2024: 117 · 2023: 102 · 2022: 73 · 2021: 40
- FWCI
- 30.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- World Journal of Emergency Surgery (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- Funders
- the manuscript was invited by the EiC/Editor and the EiC has agree to waive the APC
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Biliary and Gastrointestinal Fistulas
- Keywords
- acute calculous cholecystitis, gallbladder disease, laparoscopic cholecystectomy, subtotal cholecystectomy, gallbladder drainage, high-risk surgical patients, elderly patients, clinical scoring systems
- MeSH terms
- Cholecystectomy, Drainage, Humans, Cholecystectomy, Laparoscopic, Cholecystitis, Acute
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