Because of high mortality rate, the resection of the affected area and anastomosis may be the treatment of choice rather than RNA Synthesis inhibitor Selleckchem INCB28060 primary closure [68]. Cholecystitis Laparoscopic cholecystectomy versus open cholecystectomy question has been extensively investigated. Beginning in the early 1990s, techniques and indications for laparoscopic management of the acutely inflamed gallbladder were discussed and laparoscopic cholecystectomy is now accepted as being safe for acute cholecystitis. Compared with delayed laparoscopic cholecystectomy, early laparoscopic cholecystectomy for acute cholecystitis is safer and shows lower rates of conversions

than delay laparoscopic cholecystectomy. Several studies showed that early laparoscopic cholecystectomy resulted in a significantly reduced length of stay, no major complications, and no significant difference in conversion rates when compared with initial antibiotic treatment and delayed laparoscopic cholecystectomy [69–72]. In 2009 a prospective trial by González-Rodríguez et al. [73] about early or delayed laparoscopic cholecystectomy in acute cholecystitis

confirmed that there is no advantage in delaying cholecystectomy for acute cholecystitis on the basis of complications, rate of conversion to open surgery, and mean hospital stay. Thus, early cholecystectomy should be the preferred surgical approach for patients with acute lithiasic cholecystitis. Despite the evidence, CDK inhibitor early laparoscopic cholecystectomy is not the most common treatment for acute cholecystitis in practise and wrongly it remains common practice to treat acute cholecystitis with intravenous antibiotic therapy and interval laparoscopic cholecystectomy preferentially [74]. Surgical options in patients with severe intra-abdominal infections Patients with severe sepsis or septic shock may be complicated by high mortality rates. They may benefit of aggressive surgical treatment to

control multiple organ dysfunction syndrome caused by ongoing intra-abdominal infection. The surgical 4��8C treatment strategies following an initial emergency laparotomy may include either a relaparotomy, only when the patient’s condition demands it (“”relaparotomy on-demand”"), or a planned relaparotomy after 36-48 hours with temporarily abdomen closure or open abdomen. The aim in the on-demand laparotomy is to perform reoperation only in those patients who may benefit from it. The selection of the patients for relaparotomy is difficult and is based on clinical judgments with individual variability among surgeons. Currently, there is no consensus on which criteria may be used to undergo relaparotomy [75–80] In order to determine which variables surgeons considered important in their decisional process of patient selection for relaparotomy Van Ruler et al. [75] published in 2008 the results of a questionnaire.