Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

Released January 9, 2018; Updated January 19, 2022.

Don’t discharge patients presenting emergently with acute cholecystitis without first offering laparoscopic cholecystectomy.

Surgeons often debate the timing of cholecystectomy in patients with uncomplicated acute cholecystitis. Evidence suggests that cholecystectomy during the index hospitalization is both safe and cost effective. Interval cholecystectomy may be associated with higher chance of requiring open surgery or readmission, increasing costs. Finally, acute cholecystitis patients that are discharged without undergoing surgery may have a higher risk of presenting with complications of cholelithiasis, which can be more morbid than the initial presentation

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (composed of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely® website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM Foundation. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top recommendations were discussed by the committee and selected for inclusion in this list. The list was reviewed and approved by the SAGES Executive Committee and SAGES Board of Governors.


SAGES guideline for the clinical application of laparoscopic biliary tract surgery. Available at

Cheruvu, C.V.N. & Eyre-Brook, I.A., 2002. Consequences of prolonged wait before gallbladder surgery. Annals of the Royal College of Surgeons of England, 84(1), pp.20–22.

de Mestral C, Hoch JS, Laupacis A, et al. Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost: A Model-Based Cost-Utility Analysis. J Am Coll Surg. 2016;222(2):185-194.

Maria S Altieri , L Michael Brunt , Jie Yang , Chencan Zhu , Mark A Talamini , Aurora D Pryor. 2020 Early cholecystectomy (< 72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York. Surg Endosc. Jul;34(7):3051-3056.