This document was published more than 2 years ago. The nature of the evidence may have changed.
Surgery for cholecystitis (inflammation of the gallbladder) works best within a few days of diagnosis. The period of convalescence could be reduced by three days per patient and save SEK 26 million a year. Acute cholecystitis could be operated on even more often with laparoscopic (keyhole) technique.
The main issue in cases of acute gallstone disease is whether to operate or wait. After having reviewed available studies, SBU concluded that researchers have not found any conclusive evidence one way or the other.
“As opposed to our expectations, the scientific basis is insufficient to make a determination,” says Dr Johanna Österberg, Senior Consultant for the Surgical Department of Mora Hospital, Sweden – one of SBU's experts in the project.
The assessment showed that many patients never experienced a relapse over a period of 14 years when they choose to wait on surgery following acute gallstone disease.
“We need randomised studies of acute gallstone pain,” Dr Österberg says.
She adds that no evidence seems to discord the principle that many Swedish practitioners follow: wait after a single uncomplicated gallbladder attack, but consider operating without delay in the case of acute cholecystitis.
The SBU review still identified potential for improvement. Surgery for acute cholecystitis works best within a few days. Patients don’t have to endure waiting, risking relapse. Acute phase surgery does not increase the risk of complications, and resources are freed up.
Approximately 60% of Swedish patients currently undergo surgery during the acute phase. SBU found that some 3,300 days of convalescence and SEK 26 million would be freed up every year if the figure increased to 90%.
Laparoscopic technique instead of open surgery for acute cholecystitis substantially reduces the risk of complications, particularly wound infections and pneumonia. The majority of operations already use laproscopic technique, but there is latitude for more.
Finally, SBU points out that the Swedish national quality register enables monitoring of surgical practice for gallstone disease. [RL]
About the report: Surgery to treat gallstones and acute inflammation of the gallbladder – A systematic review and assessment of the social, medical, economic and ethical aspects (2017). Executive summary and conclusions in English
Medical and Social Science & Practice The SBU newsletter presents and disseminates the results of the SBU reports, describes ongoing projects at the agency, informs about assessment projects at sister organisations, and promotes interest in scientific assessments and critical reviews of methods in health care and social services.