Cholecystectomy in acute cholecystitis.

FOR OVER 30 years, surgeons have more and more frequently recommended early surgery in the treatment of acute cholecystitis and have preferred to remove the inflamed gallbladder at the time of surgery rather than drain it. Some surgeons and many physicians, however, continue to treat such patients medically or in a so-called conservative manner and undertake surgery only if signs of advancing inflammation develop. This conservative therapy may continue for many days before a decision is reached to remove or drain the gallbladder. Most surgeons also continue to advocate cholecystostomy in certain poor risk individuals or in those patients in whom cholecystectomy would be technically difficult. Our own preference has been to undertake immediate cholecystectomy in all patients with acute cholecystitis no matter what the patient's age or condition; we have almost never used cholecystostomy. A trial at medical or conservative therapy has its proponents, even among surgeons. Wright and