Acute suppurative cholangitis is a severe biliary tract complication requiring urgent intervention. This retrospective study analyzed 345 patients managed between 2014 and 2024 at Surgery Clinic No. 2, stratified according to Tokyo 2018 Guidelines. Initial minimally invasive decompression, mainly endoscopic, was followed by definitive surgery to restore bilio-enteric flow. Endoscopic decompression was achieved in 328 patients (95%), percutaneous transhepatic drainage in 8 (2.3%), and sequential ERCP with stenting and lavage in 36 severe cases (10.3%). Nasobiliary drainage was used in 8 patients (2.3%). Minimally invasive procedures were effective in 260 cases (75.4%), allowing laparoscopic cholecystectomy, while 85 cases (24.6%) required Roux-en-Y derivations. Postoperative mortality was 4.9% (17 patients), linked to severe, refractory forms. Staged management with urgent minimally invasive decompression proved efficient in controlling biliary infection, reducing emergency surgery, and lowering mortality.
Cotoneț et al. (Wed,) studied this question.