2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

Michele Pisano, Niccolò Allievi, Kurinchi Gurusamy, Giuseppe Borzellino, Stefania Cimbanassi, Djamila Boerna, Federico Coccolini, Andrea Tufo, Marcello Di Martino, Jeffrey Leung, Massimo Sartelli, Marco Ceresoli, Ronald V Maier, Elia Poiasina, Nicola De Angelis, Stefano Magnone, Paola Fugazzola, Ciro Paolillo, Raul Coimbra, Salomone Di Saverio, Belinda De Simone, Dieter G Weber, Boris E Sakakushev, Alessandro Lucianetti, Andrew W Kirkpatrick, Gustavo P Fraga, Imitaz Wani, Walter L Biffl, Osvaldo Chiara, Fikri Abu-Zidan, Ernest E Moore, Ari Leppäniemi, Yoram Kluger, Fausto Catena, Luca Ansaloni, Michele Pisano, Niccolò Allievi, Kurinchi Gurusamy, Giuseppe Borzellino, Stefania Cimbanassi, Djamila Boerna, Federico Coccolini, Andrea Tufo, Marcello Di Martino, Jeffrey Leung, Massimo Sartelli, Marco Ceresoli, Ronald V Maier, Elia Poiasina, Nicola De Angelis, Stefano Magnone, Paola Fugazzola, Ciro Paolillo, Raul Coimbra, Salomone Di Saverio, Belinda De Simone, Dieter G Weber, Boris E Sakakushev, Alessandro Lucianetti, Andrew W Kirkpatrick, Gustavo P Fraga, Imitaz Wani, Walter L Biffl, Osvaldo Chiara, Fikri Abu-Zidan, Ernest E Moore, Ari Leppäniemi, Yoram Kluger, Fausto Catena, Luca Ansaloni

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.

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.

Keywords: Acute cholecystitis; Antibiotics; Early and delayed cholecystectomy; Gallbladder Drainage; Guidelines; High-risk patients; Surgery.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
2020 WSES Flowchart for the management of patients with acute calcolus cholecystitis

References

    1. Shaffer EA. Epidemiology and risk factors for gallstone disease: Has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005;7(2):132–140. doi: 10.1007/s11894-005-0051-8.
    1. Kratzer W, Mason RA, Kächele V. Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound. 1999;27(1):1–7. doi: 10.1002/(SICI)1097-0096(199901)27:1<1::AID-JCU1>;2-H.
    1. Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993;165(4):399–404. doi: 10.1016/S0002-9610(05)80930-4.
    1. Attili AF, Carulli N, Roda E, et al. Epidemiology of gallstone disease in Italy: Prevalence data of the multicenter Italian study on cholelithiasis (M.I.COL.) Am J Epidemiol. 1995;141(2):158–165. doi: 10.1093/oxfordjournals.aje.a117403.
    1. Kimura Y, Takada T, Strasberg SM, et al. TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):8–23. doi: 10.1007/s00534-012-0564-0.
    1. Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin N Am. 2010;39(2):157–169. doi: 10.1016/j.gtc.2010.02.003.
    1. Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016;11(1):1-23.
    1. Yokoe M, Takada T, Strasberg SM, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos) J Hepatobiliary Pancreat Sci. 2013;20(1):35–46. doi: 10.1007/s00534-012-0568-9.
    1. Pisano M, Ceresoli M, Cimbanassi S, et al. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg. 2019;14(1):1–16. doi: 10.1186/s13017-019-0224-7.
    1. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):55–72. doi: 10.1002/jhbp.516.
    1. Loozen CS, Van Santvoort HC, Van Duijvendijk P, et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients ( CHOCOLATE ): multicentre randomised clinical trial. BMJ. 2018;363:k3965. doi: 10.1136/bmj.k3965.
    1. Trowbridge RL, Rutkowski NK, SK, et al. Does This Patient Have Acute Cholecystitis? JAMA. 2003;289(1).
    1. Eskelinen M, Ikonen JLP. Diagnostic approaches in acute cholecystitis: a prospective study of 1333 patients with acute abdominal pain. Theor Surg. 2004;8:15–20.
    1. Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos) J Hepatobiliary Pancreat Sci. 2018;25(1):41–54. doi: 10.1002/jhbp.515.
    1. Yokoe M, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2012;19(5):578–585. doi: 10.1007/s00534-012-0548-0.
    1. Janikow C, Corti E, Menso N, et al. Useful of Tokyo guidelines in the diagnosis of acute cholecystitis. Anatomopathologie correlationship. Rev Fac Cien Med Univ Nac Cordoba. 2017;74(2):88–92. doi: 10.31053/1853.0605.v74.n2.13352.
    1. Naidu K, Beenen E, Gananadha S, Mosse C. The Yield of Fever, Inflammatory Markers and Ultrasound in the Diagnosis of Acute Cholecystitis: A Validation of the 2013 Tokyo Guidelines. World J Surg. 2016;40(12):2892–2897. doi: 10.1007/s00268-016-3660-5.
    1. Joseph B, Jehan F, Dacey M, et al. Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. J Am Coll Surg. 2018;227(1):38–43. doi: 10.1016/j.jamcollsurg.2018.02.016.
    1. Kiewiet JJS, Leeuwenburgh MMN, Bipat S, et al. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology. 2012;264(3):708–720. doi: 10.1148/radiol.12111561.
    1. Changphaisarnkul P, Saengruang-Orn S, Boonya-Asadorn T. The Diagnosis of Acute Cholecystitis: Sensitivity of Sonography, Cholescintigraphy and Computed Tomography. J Med Assoc Thail. 2015;98(8):812–819.
    1. Fagenholz PJ, Fuentes E, Kaafarani H, et al. Computed Tomography Is More Sensitive than Ultrasound for the Diagnosis of Acute Cholecystitis. Surg Infect. 2015;16(5):509–512. doi: 10.1089/sur.2015.102.
    1. Kaoutzanis C, Davies E, Leichtle SW, et al. Is hepato-imino diacetic acid scan a better imaging modality than abdominal ultrasound for diagnosing acute cholecystitis? Am J Surg. 2015;210(3):473–482. doi: 10.1016/j.amjsurg.2015.03.005.
    1. Villar J, Summers SM, Menchine MD, et al. The Absence of Gallstones on Point-of-Care Ultrasound Rules Out Acute Cholecystitis. J Emerg Med. 2015;49(4):475–480. doi: 10.1016/j.jemermed.2015.04.037.
    1. Rodriguez LE, Santaliz-Ruiz LE, De La Torre-Bisot G, et al. Clinical implications of hepatobiliary scintigraphy and ultrasound in the diagnosis of acute cholecystitis. Int J Surg. 2016;35:196–200. doi: 10.1016/j.ijsu.2016.09.084.
    1. Stogryn S, Metcalfe J, Vergis A, et al. Does ultrasongraphy predict intraoperative findings at cholecystectomy? An institutional review. Can J Surg. 2016;59(1):12–18. doi: 10.1503/cjs.005915.
    1. Kim JE, Choi DS, Bae K, et al. Added value of point shear-wave elastography in the diagnosis of acute cholecystitis. Eur Radiol. 2017;27(4):1517–1526. doi: 10.1007/s00330-016-4509-x.
    1. Ra JC, Lee ES, Park HJ, et al. Efficacy of Superb Microvascular Imaging for Diagnosing Acute Cholecystitis: Comparison with Conventional Ultrasonography. Ultrasound Med Biol. 2018;44(9):1968–1977. doi: 10.1016/j.ultrasmedbio.2018.05.014.
    1. Kim SW, Kim HC, Yang DM, Won KY, Moon SK. Cystic Duct Enhancement: A Useful CT Finding in the Diagnosis of Acute Cholecystitis Without Visible Impacted Gallstones. Am J Roentgenol. 2015;205(5):991–998. doi: 10.2214/AJR.15.14403.
    1. Carter SS, Ehsan SR, Duszak R, et al. A Novel Timesaving Method for Hepatobiliary Imaging for Suspected Acute Cholecystitis. Curr Probl Diagn Radiol. 2017;46(1):6–9. doi: 10.1067/j.cpradiol.2016.04.005.
    1. Peng WK, Sheikh Z, Paterson-Brown S, et al. Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg. 2005;92(10):1241–1247. doi: 10.1002/bjs.4955.
    1. Khalfallah M, Dougaz W, Bedoui R, et al. Validation of the Lacaine-Huguier predictive score for choledocholithiasis: prospective study of 380 patients. J Visc Surg. 2012;149(1):66–72. doi: 10.1016/j.jviscsurg.2011.11.001.
    1. Csendes A, Burdiles P. Diaz JCet al. Prevalence of common bile duct stones according to the increasing number of risk factors present. A prospective study employing routinely intraoperative cholangiography in 477 cases. Hepatogastroenterology. 1998;45(23):1415–1421.
    1. Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002;56(6 Suppl):S165–S169. doi: 10.1016/S0016-5107(02)70005-9.
    1. Safioleas M, Stamatakos M, Revenas C, et al. An alternative surgical approach to a difficult case of Mirizzi syndrome: a case report and review of the literature. World J Gastroenterol. 2006;12(34):5579–5581. doi: 10.3748/wjg.v12.i34.5579.
    1. Erben Y, Benavente-Chenhalls LA, Donohue JM, et al. Diagnosis and treatment of Mirizzi syndrome: 23-year Mayo Clinic experience. J Am Coll Surg. 2011;213(1):114–119. doi: 10.1016/j.jamcollsurg.2011.03.008.
    1. Ahn KS, Yoon YS, Han HSCJ. Use of Liver Function Tests as First-line Diagnostic Tools for Predicting Common Bile Duct Stones in Acute Cholecystitis Patients. World J Surg. 2016;40(8):1925–1931. doi: 10.1007/s00268-016-3517-y.
    1. Yang M-H, Chen T-H, Wang S-E, et al. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2008;22(7):1620–1624. doi: 10.1007/s00464-007-9665-2.
    1. Barkun AN, Barkun JS, Fried GM, et al. Useful Predictors of Bile Duct Stones in Patients Undergoing Laparoscopic Cholecystectomy. Ann Surg. 1994;220(1):32–39. doi: 10.1097/00000658-199407000-00006.
    1. Onken JE, Brazer SR, Eisen GM, et al. Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol. 1996;91(4):762–767.
    1. Song SH, Kwon C-I, Jin SM, et al. Clinical characteristics of acute cholecystitis with elevated liver enzymes not associated with choledocholithiasis. Eur J Gastroenterol Hepatol. 2014;26(4):452–457. doi: 10.1097/MEG.0000000000000053.
    1. Chang C, Chang W, Lin C, et al. Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis. 2009;15(30):3788–92.
    1. Padda MS, Singh S, Tang SJ, et al. Liver test patterns in patients with acute calculous cholecystitis and/or choledocholithiasis. Aliment Pharmacol Ther. 2009;29(9):1011–1018. doi: 10.1111/j.1365-2036.2009.03956.x.
    1. Gurusamy K, Giljaca V, Takwoingi Y, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. Cochrane Database Syst Rev. 2015;2:CD011548.
    1. Boys JA. D M, Doorly MG, et al. Can ultrasound common bile duct diameter predict common bile duct stones in the setting of acute cholecystitis ? Am J Surg. 2020;207(3):432–435. doi: 10.1016/j.amjsurg.2013.10.014.
    1. Menezes N, Marson LP. C A, Muir IM, Auld CD. Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg. 2000;87(9):1176–1181. doi: 10.1046/j.1365-2168.2000.01511.x.
    1. Soltan HM, Kow L, Toouli J. A Simple Scoring System for Predicting Stones in Patients With Cholelithiasis. J Gatrointest Surg. 2001;5(4):434–437. doi: 10.1016/S1091-255X(01)80073-1.
    1. Sun X, Cai X, Li J, et al. Prospective study of scoring system in selective intraoperative cholangiography during laparoscopic cholecystectomy. World J Gastroenterol. 2003;9(4):865–867. doi: 10.3748/wjg.v9.i4.865.
    1. Sarli L, Costi R, Gobbi S, et al. Asymptomatic bile duct stones: selection criteria for intravenous cholangiography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy. Eur J Gastroenterol Hepatol. 2000;12:1175–1180. doi: 10.1097/00042737-200012110-00002.
    1. Maple JT, Ben-Menachem T, Anderson MA, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1–9. doi: 10.1016/j.gie.2009.09.041.
    1. Kaltenthaler E, Vergel YB, Chilcott J, et al. A Systematic Review and Economic Evaluation of Magnetic Resonance Cholangiopancreatography Compared With Diagnostic Endoscopic Retrograde Cholangiopancreatography. Health Technol Assess. 2004;8(19):1–89.
    1. Toppi JT, Johnson MA, Page P, Fox A. Magnetic resonance cholangiopancreatography : utilization and usefulness in suspected choledocholithiasis. ANZ J Surg. 2016;86(12):1028–1032. doi: 10.1111/ans.12867.
    1. Giljaca V, Ks G, Takwoingi Y, et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Database Syst Rev. 2015;2:CD011549.
    1. Ledro-cano D. Suspected choledocholithiasis : endoscopic ultrasound or magnetic resonance cholangio-pancreatography ? A systematic review. Eur J Gastroenterol Hepatol. 2007;19(11):1007–1011. doi: 10.1097/MEG.0b013e328133f30b.
    1. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918. doi: 10.1056/NEJM199609263351301.
    1. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP : a prospective multicenter study. Gastrointest Endosc. 1998:1–10.
    1. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective, multicenter study. Am J Gastroenterol. 2001;96:417–423. doi: 10.1111/j.1572-0241.2001.03594.x.
    1. Cotton PB, Garrow DA, Gallagher J. Risk factors for complications after ERCP : a multivariate analysis of 11 , 497 procedures over 12 years. Gastrointest Endosc. 2020;70(1):80–88. doi: 10.1016/j.gie.2008.10.039.
    1. Ford JA, Soop M, Du J, et al. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg. 2012;99(2):160–167. doi: 10.1002/bjs.7809.
    1. Biffl WL, Moore EE, Offner PJ, et al. Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy. J Am Coll Surg. 2001;193(3):272–280. doi: 10.1016/S1072-7515(01)00991-7.
    1. Aziz O, Ashra H, Jones C, et al. Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy : A meta-analysis of diagnostic accuracy. 2020;12(2014):712–9.
    1. Dasari BVM, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013;(9):CD003327.
    1. Wang B, Guo Z, Liu Z. Preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones : system review and meta-analysis. Surg Endosc. 2013;27(7):2454–2465. doi: 10.1007/s00464-012-2757-7.
    1. Borzellino G, Sauerland S, Minicozzi AM, et al. Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc Other Interv Tech. 2008;22(1):8–15. doi: 10.1007/s00464-007-9511-6.
    1. Kiviluoto T, Sirén J, Luukkonen P, et al. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998;351(9099):321–325. doi: 10.1016/S0140-6736(97)08447-X.
    1. Johansson M, Thune A, Nelvin L, et al. Randomized clinical trial of open versus laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2005;92(1):44–49. doi: 10.1002/bjs.4836.
    1. Boo YJ, Kim WB, Kim J, et al. Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: A prospective randomized study. Scand J Clin Lab Invest. 2007;67(2):207–214. doi: 10.1080/00365510601011585.
    1. Catena F, Ansaloni L, Di Saverio S, et al. The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study: Multicenter randomized, double-blind, controlled trial of laparoscopic (LC) versus open (LTC) surgery for acute cholecystitis (AC) in adults. Trials. 2008;9:1–5. doi: 10.1186/1745-6215-9-1.
    1. Pessaux P, Regenet N, Tuech JJ, et al. Laparoscopic versus open cholecystectomy: A prospective comparative study in the elderly with acute cholecystitis. Surg Laparosc Endosc Percutaneous Tech. 2001;11(4):252–255. doi: 10.1097/00129689-200108000-00005.
    1. Araujo-Teixeira JP, Rocha-Reis J, Costa-Cabral A, et al. Laparoscopie ou laparotomie dans la cholecystite aigue (200 cas). Comparaison des resultats et facteurs predisposant a la conversion. Chirurgie. 1999;124(5):529–535. doi: 10.1016/S0001-4001(00)88276-8.
    1. Chau CH, Tang CN, Siu WT, et al. Laparoscopic cholecystectomy versus open cholecystectomy in elderly patients with acute cholecystitis: Retrospective study. Hong Kong Med J. 2002;8(6):394–399.
    1. Unger SW, Rosenbaum G, Unger HM, et al. A comparison of laparoscopic and open treatment of acute cholecystitis. Surg Endosc. 1993;7(5):408–411. doi: 10.1007/BF00311731.
    1. Eldar S, Sabo ENE, et al. Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg Laparosc Endosc. 1997;7:407–414. doi: 10.1097/00019509-199710000-00010.
    1. Glavic Z, Begic L, Simlesa D, et al. Treatment of acute cholecystitis: A comparison of open vs laparoscopic cholecystectomy. Surg Endosc. 2001;15(4):398–401. doi: 10.1007/s004640000333.
    1. Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections worldwide : the definitive data of the CIAOW Study. World J Emerg Surg. 2014;9:37. doi: 10.1186/1749-7922-9-37.
    1. Coccolini F, Catena F, Pisano M, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015;18:196–204. doi: 10.1016/j.ijsu.2015.04.083.
    1. Song G-M, Wei Bian X-TZ, et al. Laparoscopic cholecystectomy for acute cholecystitis: early or delayed? Evidence from a systematic review of discordant meta-analyses. Medicine (Baltimore). 2016;95(23).
    1. Yamashita Y, Takada T, Strasberg SM, et al. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):89–96. doi: 10.1007/s00534-012-0567-x.
    1. Okamoto K, Suzuki K, Takada T, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):55–72. doi: 10.1002/jhbp.516.
    1. De Goede B, Klitsie PJ, Hagen SM, et al. Meta-analysis of laparoscopic versus open cholecystectomy for patients with liver cirrhosis and symptomatic cholecystolithiasis. Br J Surg. 2013;100(2):209–216. doi: 10.1002/bjs.8911.
    1. Lucidi V, Buggenhout A, Donckier V. Cholecystectomy in cirrhotic patients : Pitfalls and reasonable recommendations. Acta Chir Belg. 2009;109(4):477–480. doi: 10.1080/00015458.2009.11680463.
    1. Puggioni A, Wong LL. A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis. J Am Coll Surg. 2003;197(6):921–926. doi: 10.1016/j.jamcollsurg.2003.08.011.
    1. Mancero JMP, D’Albuquerque LAC, Gonzalez AM, Larrea FIS, De Oliveira E Silva A. Laparoscopic cholecystectomy in cirrhotic patients with symptomatic cholelithiasis: A case-control study. World J Surg. 2008;32(2):267–270. doi: 10.1007/s00268-007-9314-x.
    1. Perkins L, Jeffries M, Patel T. Utility of preoperative scores for predicting morbidity after cholecystectomy in patients with cirrhosis. Clin Gastroenterol Hepatol. 2004;2(12):1123–1128. doi: 10.1016/S1542-3565(04)00547-6.
    1. Palanivelu C, Rajan PS, Jani K, et al. Laparoscopic Cholecystectomy in Cirrhotic Patients: The Role of Subtotal Cholecystectomy and Its Variants. J Am Coll Surg. 2006;203(2):145–151. doi: 10.1016/j.jamcollsurg.2006.04.019.
    1. Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for “Difficult gallbladders”: Systematic review and meta-analysis. JAMA Surg. 2015;150(2):159–168. doi: 10.1001/jamasurg.2014.1219.
    1. Wiggins T, Markar SR, Mackenzie H, et al. Evolution in the management of acute cholecystitis in the elderly: population-based cohort study. Surg Endosc. 2018;32(10):4078–4086. doi: 10.1007/s00464-018-6092-5.
    1. Tsimoyiannis EC, Antoniou NC, Tsaboulas C, et al. Cholelithiasis during pregnancy and lactation. Prospective study. Eur J Surg. 1994;160(11):627–631.
    1. Basso L, McCollum PT, Darling MR, et al. A study of cholelithiasis during pregnancy and its relationship with age, parity, menarche, breast-feeding, dysmenorrhea, oral contraception and a maternal history of cholelithiasis. Surg Gynecol Obstet. 1992;172(1):41–46.
    1. Hiatt JR, Hiatt JCG, Williams RA, et al. Biliary disease in pregnancy: Strategy for surgical management. Am J Surg. 1986;151(2):263–265. doi: 10.1016/0002-9610(86)90083-8.
    1. Scott LD. Gallstone disease and pancreatitis in pregnancy. Gastroenterol Clin N Am. 1992;21(4):803–815.
    1. Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am. 2000;80(4):1093–1110. doi: 10.1016/S0039-6109(05)70215-2.
    1. Sedaghat N, Cao AM, Eslick GD, et al. Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis. Surg Endosc. 2017;31(2):673–679. doi: 10.1007/s00464-016-5019-2.
    1. Shigemi D, Aso S, Matsui H, et al. Safety of Laparoscopic Surgery for Benign Diseases during Pregnancy: A Nationwide Retrospective Cohort Study. J Minim Invasive Gynecol. 2019;26(3):501–506. doi: 10.1016/j.jmig.2018.06.008.
    1. Cosenza CA, Saffari B, Jabbour N, et al. Surgical management of biliary gallstone disease during pregnancy. Am J Surg. 1999;178(6):545–548. doi: 10.1016/S0002-9610(99)00217-2.
    1. Ball E, Waters N, Cooper NTC, et al. Evidence-Based Guideline on Laparoscopy in Pregnancy. Facts Views Vis Obgyn. 2019;11(1):5–25.
    1. Hussain A. Difficult laparoscopic cholecystectomy: Current evidence and strategies of management. Surg Laparosc Endosc Percutaneous Tech. 2011;21(4):211–217. doi: 10.1097/SLE.0b013e318220f1b1.
    1. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010;211(1):132–138. doi: 10.1016/j.jamcollsurg.2010.02.053.
    1. Purzner RH, Ho KB, Al-Sukhni EJS. Safe laparoscopic subtotal cholecystectomy in the face of severe inflammation in the cystohepatic triangle: a retrospective review and proposed management strategy for the difficult gallbladder. Can J Surg. 2019;62(6):402–411. doi: 10.1503/cjs.014617.
    1. Sabour AF, Matsushima K, Love BE, et al. Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis. Surg (United States) 2019;2019:1–6.
    1. Brahmbhatt TS, Martin MJ. Subtotal cholecystectomy as an effective and safe option for complicated cholecystitis: A 2018 EAST Master Class Video Presentation. J Trauma Acute Care Surg. 2018;85(1):235–238. doi: 10.1097/TA.0000000000001888.
    1. Qazi AR, Solangi RA, SP et al. Reasons for conversion from laparoscopic to open cholecystectomy. Med Forum Mon. 2010;21(3):13–17.
    1. Mannino M, Toro A, Teodoro M, et al. Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects. World J Emerg Surg. 2019;14(1):10–13. doi: 10.1186/s13017-019-0227-4.
    1. Gupta V, Jain G. Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg. 2019;11(2):62–84. doi: 10.4240/wjgs.v11.i2.62.
    1. Strasberg SM. A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci. 2019;26(4):123–127. doi: 10.1002/jhbp.616.
    1. Schmidt M, Sondenaa KVM, et al. Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: non-operative management is an option in some patients. Scand J Gastroenterol. 2011;46:1257–1262. doi: 10.3109/00365521.2011.598548.
    1. Vetrhus M, Søreide O, Nesvik I, Søndenaa K. Acute cholecystitis: Delayed surgery or observation. A randomized clinical trial. Scand J Gastroenterol. 2003;38(9):985–990. doi: 10.1080/00365520310004056.
    1. Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev. 2013;2013(6).
    1. Davila D, Manzanares C, PM, et al. Experience in the treatment (early vs. delayed) of acute cholecystitis via laparoscopy. Cir Esp. 1999;66(233).
    1. Gul R, Dar RA, Sheikh RA, et al. Comparison of early and delayed laparoscopic cholecystectomy for acute cholecystitis: Experience from a single center. N Am J Med Sci. 2013;5(7):414–418. doi: 10.4103/1947-2714.115783.
    1. Rajcok M, Bak V, Danihel L, et al. Early versus delayed laparoscopic cholecystectomy in treatment of acute cholecystitis. Bratislava Med J. 2016;117(6):328–331. doi: 10.4149/BLL_2016_065.
    1. Roulin D, Saadi A, Di Mare L, et al. Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule? A randomized trial. Ann Surg. 2016;264(5):717–722. doi: 10.1097/SLA.0000000000001886.
    1. Saber A, Hokkam EN. Operative outcome and patient satisfaction in early and delayed laparoscopic cholecystectomy for acute cholecystitis. Minim Invasive Surg. 2014;2014.
    1. Verma S, Agarwal PN, Bali RS, et al. Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective Randomized Trial. ISRN Minim Invasive Surg. 2013;2013:1–3. doi: 10.1155/2013/486107.
    1. Yadav RP, Adhikary S, Agrawal CS, et al. A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis. Kathmandu Univ Med J. 2009;7(25):16–20.
    1. Zahur S, Rabbani S. Imran Hussain Andrabi S, wt al.Early Vs Interval Cholecystectomy in Acute Cholecystitis: An Experience at Ghurki Trust Teaching Hospital, Lahore. PJMHS. 2014;8(3):778–781.
    1. Gutt CN, Encke J, Köninger J, et al. Acute cholecystitis: Early versus delayed cholecystectomy, a multicenter randomized trial (ACDC Study, NCT00447304) Ann Surg. 2013;258:385–391. doi: 10.1097/SLA.0b013e3182a1599b.
    1. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of Acute Cholecystitis in the Laparoscopic Era: Results of a Prospective, Randomized Clinical Trial. J Gastrointest Surg. 2003;7(5):642–645. doi: 10.1016/S1091-255X(03)00065-9.
    1. Kolla SB, Aggarwal S, Kumar A, et al. Early vs delayed laparoscopic cholecystectomy for acute cholecystitis: A prospective randomized trial. Surg Endosc Other Interv Tech. 2004;18(9):1323–1327. doi: 10.1007/s00464-003-9230-6.
    1. Lai PBS, Kwong KH, Leung KL, et al. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998;85(6):764–767. doi: 10.1046/j.1365-2168.1998.00708.x.
    1. Lo C-M, Liu C-L, Fan S-T, Glas F, Lai EC, Wong J. Prospective Randomized Study of Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis. Ann Surg. 1998;227(4):461–467. doi: 10.1097/00000658-199804000-00001.
    1. Macafee DAL, Humes DJ, Bouliotis G, et al. Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg. 2009;96:1031–1040. doi: 10.1002/bjs.6685.
    1. Issa M, Mustafa T, Issa A, Chaudhry SM. Early vs Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis. PJMHS. 2016;10(2):371–373.
    1. Özkardeş AB, Tokaç M, Dumlu EG, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: A prospective, randomized study. Int Surg. 2014;99(1):56–61. doi: 10.9738/INTSURG-D-13-00068.1.
    1. Huntington CR, Cox TC, Blair LJ, et al. Nationwide variation in outcomes and cost of laparoscopic procedures. Surg Endosc. 2016;30(3):934–946. doi: 10.1007/s00464-015-4328-1.
    1. Pucher PH, Brunt LM, Davies N, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175–2183. doi: 10.1007/s00464-017-5974-2.
    1. Törnqvist B, Strömberg C, Persson G, et al. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: Population based cohort study. BMJ. 2012;345(7880).
    1. Alvarez FA, De Santibañes M, Palavecino M, et al. Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg. 2014;101(6):677–684. doi: 10.1002/bjs.9486.
    1. Schmidt M, Søndenaa K, Vetrhus M, et al. Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: Non-operative management is an option in some patients. Scand J Gastroenterol. 2011;46(10):1257–1262. doi: 10.3109/00365521.2011.598548.
    1. Boddy AP, Bennett JMH, Ranka S, et al. Who should perform laparoscopic cholecystectomy? A 10-year audit. Surg Endosc Other Interv Tech. 2007;21(9):1492–1497. doi: 10.1007/s00464-007-9291-z.
    1. Andrews S. Does concentration of surgical expertise improve outcomes for laparoscopic cholecystectomy? 9 year audit cycle. Surgeon. 2013;11(6):309–312. doi: 10.1016/j.surge.2013.06.005.
    1. Tufo A, Reuver Pd L, et al. Risk prediction in acute calculous cholecystitis : a systematic review of prognostic factors and predictive models and meta-analysis. J Laparoendosc Adv Surg Tech. 2020; (Accepted for publication).
    1. Schweitzer L, Geisler C, Pourhassan M, et al. Estimation of Skeletal Muscle Mass and Visceral Adipose Tissue Volume by a Single Magnetic Resonance Imaging Slice in Healthy Elderly Adults. J Nutr. 2016;146(10):2143–2148. doi: 10.3945/jn.116.236844.
    1. Abe T, Kearns CF, Fukunaga T. Sex differences in whole body skeletal muscle mass measured by magnetic resonance imaging and its distribution in young Japanese adults. Br J Sports Med. 2003;37(5):436–440. doi: 10.1136/bjsm.37.5.436.
    1. Rattarasarn C, Leelawattana R, Soonthornpun S, et al. Gender differences of regional abdominal fat distribution and their relationships with insulin sensitivity in healthy and glucose-intolerant thais. J Clin Endocrinol Metab. 2004;89(12):6266–6270. doi: 10.1210/jc.2004-0209.
    1. Després J-P, Couillard C, Gagnon J, et al. Race, Visceral Adipose Tissue, Plasma Lipids, and Lipoprotein Lipase Activity in Men and Women The Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol. 2000;20(8):1932–1938. doi: 10.1161/01.ATV.20.8.1932.
    1. Shalev V, Chodick G, Heymann AD, et al. Gender differences in healthcare utilization and medical indicators among patients with diabetes. Public Health. 2005;119(1):45–49. doi: 10.1016/j.puhe.2004.03.004.
    1. Himmelstein MS, Sanchez DT. Masculinity impediments: Internalized masculinity contributes to healthcare avoidance in men and women. J Health Psychol. 2016;21(7):1283–1292. doi: 10.1177/1359105314551623.
    1. Ellis H, Moran BJ, Thompson JN, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476–1480. doi: 10.1016/S0140-6736(98)09337-4.
    1. Brazzelli M, Cruickshank MKM, et al. Systematic review of the clinical and cost effectiveness of cholecystectomy versus observation/conservative management for uncomplicated symptomatic gallstones or cholecystitis. Surg Endosc. 2015;29:637–647. doi: 10.1007/s00464-014-3712-6.
    1. Mori Y, Itoi T, Baron TH, et al. Tokyo Guidelines 2018 : management strategies for gallbladder drainage in patients with acute cholecystitis ( with videos ) J Hepatobiliary Pancreat Sci. 2018;25(1):87–95. doi: 10.1002/jhbp.504.
    1. Ambe PC, Kaptanis S, Papadakis M, Weber SA, Jansen S, Zirngibl H. The Treatment of Critically Ill Patients With Acute Cholecystitis. Dtsch Arztebl Int. 2016;11:545–551.
    1. Winbladh A, Gullstrand P, Svanvik J, et al. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. Hpb. 2009;11(3):183–193. doi: 10.1111/j.1477-2574.2009.00052.x.
    1. Campanile FC, Pisano M, Coccolini F, et al. Acute cholecystitis: WSES position statement. World J Emerg Surg. 2014;9(1):1–6. doi: 10.1186/1749-7922-9-58.
    1. Barak O, Elazary R, Appelbaum L, Rivkind A, Almogy G. Conservative treatment for acute cholecystitis: Clinical and radiographic predictors of failure. Isr Med Assoc J. 2009;11(12):739–743.
    1. de Mestral C, Rotstein OD, Laupacis A, et al. A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy. J Trauma Acute Care Surg. 2013;74(1):26–30. doi: 10.1097/TA.0b013e3182788e4d.
    1. Tsuyuguchi T, Itoi T, Takada T, Strasberg SM, et al. TG13 indications and techniques for gallbladder drainage in acute cholecystitis ( with videos ) J Hepatobiliary Pancreat Sci. 2013;20(1):81–88. doi: 10.1007/s00534-012-0570-2.
    1. Ho J, Chan Y, Yuen A, Teoh B. Current Status of Endoscopic Gallbladder Drainage. Clin Endosc. 2018;51(2):150–155. doi: 10.5946/ce.2017.125.
    1. Anderloni A, Buda A, Vieceli F, et al. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis : a systematic review and pooled analysis. Surg Endosc. 2016;30(12):5200–5208. doi: 10.1007/s00464-016-4894-x.
    1. Itoi T, Coelho-prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. YMGE. 2010;71(6):1038–1045.
    1. Itoi T, Kawakami H, Katanuma A, Irisawa A. Endoscopic nasogallbladder tube or stent placement in acute cholecystitis : a preliminary prospective randomized trial in Japan ( with videos ) Gastrointest Endosc. 2015;81(1):111–118. doi: 10.1016/j.gie.2014.09.046.
    1. Jang JIW, Lee SSOO, Song TAEJUN, et al. Endoscopic Ultrasound-Guided Transmural and Percutaneous Transhepatic. YGAST. 2012;142(4):805–811.
    1. Irani S, Ngamruenphong S, TA et al. Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent versus percutaneous transhepatic gallbladder drainage for acute cholecystitis. Clin Hepatol Gastroenterol. 2017;15:738–745. doi: 10.1016/j.cgh.2016.12.021.
    1. Khan MA, Atiq O, Kubiliun N, et al. Ef fi cacy and safety of endoscopic gallbladder drainage in acute cholecystitis : Is it better than percutaneous gallbladder drainage ? Gastrointest Endosc. 2017;85(1):76–87. doi: 10.1016/j.gie.2016.06.032.
    1. Ahmed O, Ogura TEA, et al. Endoscopic ultrasound-guided drainage in acute cholecystitis: results of a long-term follow-up. Saudi J Gastroenterol. 2018;24:183–188. doi: 10.4103/sjg.SJG_506_17.
    1. Law R, Grimm ISSJ, et al. Conversion of percutaneous cholecystostomy to internal transmural gallbladder drainage using an endoscopic ultrasound-guided, lumen-apposing metal stent. Clin Hepatol Gastroenterol. 2016;14:476–480. doi: 10.1016/j.cgh.2015.10.026.
    1. Chantarojanasiri T, Matsubara SIH, et al. Feasibility of conversion of percutaneous cholecystestomy to internal transmural endoscopic ultrasound-guided gallbladder drainage. Saudi J Gastroenterol. 2017;23:318–322. doi: 10.4103/sjg.SJG_115_17.
    1. Teoh AYB, Kitano M, Itoi T, et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: An international randomised multicentre controlled superiority trial (DRAC 1). Gut. 2020:1–7.
    1. De Serna-higuera C, Pérez-miranda M, Gil-simón P, Ruiz-zorrilla R. EUS-guided transenteric gallbladder drainage with a new fistula-forming , lumen-apposing metal stent. YMGE. 2013;77(2):303–308.
    1. Kamata K, Takenaka M, Kitano M, et al. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis : Long-term outcomes after removal of a self-expandable metal stent. World J Gastroenterol. 2017;23(4):661–667. doi: 10.3748/wjg.v23.i4.661.
    1. Irani S, Baron THGI, et al. EUS-guided gallbladder drainage with lumen-apposing metal stent (with video) Gastrointest Endosc. 2015;82:1110–1115. doi: 10.1016/j.gie.2015.05.045.
    1. Dollhopf M, Larghi A, Will U, et al. EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device. Gastrointest Endosc. 2017;86(4):636–643. doi: 10.1016/j.gie.2017.02.027.
    1. Walter D, Teoh AY, Itoi T, et al. EUS-guided gall bladder drainage with a lumen-apposing metal stent : a prospective long-term evaluation. 2016. pp. 6–8.
    1. Regimbeau M, Fuks D, et al. Effect of Postoperative Antibiotic Administration on Postoperative Infection Following Cholecystectomy for Acute Calculous Cholecystitis A Randomized Clinical Trial. JAMA. 2014;312(2):145–154. doi: 10.1001/jama.2014.7586.
    1. Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections in Europe : a comprehensive review of the CIAO study. World J Emerg Surg. 2012;7(1):36. doi: 10.1186/1749-7922-7-36.
    1. Sartelli M, Viale P, Catena F, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013;8(1):3. doi: 10.1186/1749-7922-8-3.
    1. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children : Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(2):133–164. doi: 10.1086/649554.
    1. Dhalluin-Venier V, Bazin C, Massias L, Bou R, Boytchev I, Fritsch J, Buffet C. Effects of biliary obstruction on the penetration of ciprofloxacin and cefotaxime. Eur J Gastroenterol Hepatol. 2005;20(2):127–130. doi: 10.1097/MEG.0b013e3282f1c985.
    1. H-P. S. Antibiotics in Laboratory Medicine (Second Edition). V Lorian, Ed 1259 S, 371 Abb, 323 Tab Balt Angeles-Sydney Williams Wilkins J Basic Microbiol. 1986.
    1. Sartelli M, Catena F, Di Saverio S, et al. Current concept of abdominal sepsis : WSES position paper. World J Emerg Surg. 2014;9(1):1–16. doi: 10.1186/1749-7922-8-1.
    1. Riché FC, Dray X, Laisné M, et al. Factors associated with septic shock and mortality in generalized peritonitis : comparison between community-acquired and postoperative peritonitis. Crit Care. 2009;13(3):1–9. doi: 10.1186/cc7931.
    1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med. 2008;36(1):296–327. doi: 10.1097/01.CCM.0000298158.12101.41.
    1. Singer M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287.
    1. Pea F, Viale P. Bench-to-bedside review : Appropriate antibiotic therapy in severe sepsis and septic shock - does the dose matter ? Crit Care. 2009;13:1–13. doi: 10.1186/cc7774.
    1. Csendes A, Becerra M, Burdiles P, et al. Bacteriological studies of bile from the gallbladder in patients with carcinoma of the gallbladder, cholelithiasis, common bile duct stones and no gallstones disease. Eur J Surg. 1994;160:363–367.
    1. Csendes A, Burdiles P, Maluenda F, et al. Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones. Arch Surg. 1996;31:389–394. doi: 10.1001/archsurg.1996.01430160047008.
    1. Csendes A, Mitru N, Maluenda F, et al. Counts of bacteria and pyocites of choledochal bile in controls and in patients with gallstones or common bile duct stones with or without acute cholangitis. Hepatogastroenterology. 1996;43:800–806.
    1. Maluenda F, Csendes A, Burdiles PDJ. Bacteriological study of choledochal bile in patients with common bile duct stones, with or without acute suppurative cholangitis. Hepatogastroenterology. 1989;36:132–135.
    1. Chang W, Lee K, Wang S, et al. Bacteriology and antimicrobial susceptibility in biliary tract disease: an audit of 10-year’s experience. Kaohsiung J Med Sci. 2002:221–8.
    1. Salvador V, Lozada MCR. Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian Academic Medical Center. Surg Infect. 2011;12:105–111. doi: 10.1089/sur.2010.005.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren