Early laparoscopic cholecystectomy is considered the treatment of choice for most patients with acute cholecystitis. In randomized and prospective trials comparing early laparoscopic cholecystectomy (generally defined as at the time of the initial attack but can be defined as late as 7 days after the onset of symptoms) with a delayed procedure (2 to 3 months after the initial attack), as well as in meta-analyses, early treatment has consistently been associated with shorter overall hospitalization.
In the small minority of patients with severe acute cholecystitis, initial conservative management with antibiotics is recommended, preferably in a high-acuity setting, with the use of percutaneous cholecystostomy as needed; surgery is reserved for patients in whom non-surgical treatment fails.
New England Journal of Medicine - Vol. 358, No. 26, June 26, 2008