Looking for the best practice for acute cholecystitis

Professor Stanley Ashley kindly delivered a special lecture titled ‘Advances in the management of acute cholecystitis’ at the 16th Annual Meeting of the Japanese Society of Gastroenterological Surgery. Based on that lecture, Prof. Ashley and his colleagues have written an informative review article in this issue of the Annals of Gastroenterological Surgery.1 Diagnostic and therapeutic strategies in acute cholecystitis (AC) are, indeed, continuing concerns. Furthermore, the safety of laparoscopic cholecystectomy (LC) remains a matter of controversy. As AC is one of the most frequently encountered acute abdominal diseases worldwide, it is of keen interest not only to surgeons, but also to endoscopists. Worldwide, the Tokyo Guidelines are unique because of their useful diagnostic and grading systems; however, several recent clinical studies have raised questions about their universality for application to the global population. Concerning therapeutic strategies, Prof. Ashley raised several problems to be resolved, such as timing of surgery, role of percutaneous cholecystostomy (PC), and safety of surgical procedures in difficult cholecystectomy