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Among the most common surgically treated conditions in the USA, appropriate diagnosis and management of <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content> require astute clinical judgment and operative skill. Useful diagnostic and grading systems have been developed, most notably the Tokyo guidelines, but some recent clinical validation studies have questioned their generalizability to the US population. The timing of surgical intervention is another area that requires further investigation. US surgeons traditionally pursue laparoscopic cholecystectomy (<jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content>) for <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content> patients with symptoms onset &lt;72\u00a0hours, but for patients with symptoms over 72\u00a0hours, surgeons often elect to treat the patients with antibiotics and delay <jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content> for 4\u20106\u00a0weeks to permit the inflammation to subside. This practice has recently been called into question, as there are data suggesting that <jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content> even for <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content> patients with over 72\u00a0hours of symptoms confers decreased morbidity, shorter length of stay, and reduced overall healthcare costs. Finally, the role of percutaneous cholecystostomy (<jats:styled-content style=\"fixed-case\">PC<\/jats:styled-content>) needs to be better defined. Traditional role of <jats:styled-content style=\"fixed-case\">PC<\/jats:styled-content> is a temporizing measure for patients who are poor surgical candidates. However, there are data suggesting that in <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content> patients with organ failure, <jats:styled-content style=\"fixed-case\">PC<\/jats:styled-content> patients suffered higher mortality and readmission rates when compared with a propensity\u2010matched <jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content> cohort. Beyond diagnosis, the surgical management of <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content> can be remarkably challenging. All surgeons need to be familiar with best\u2010practice surgical techniques, adjunct intra\u2010operative imaging, and bail\u2010out options when performing <jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content>.<\/jats:p>","DOI":"10.1002\/ags3.12240","type":"journal-article","created":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T14:04:58Z","timestamp":1550585098000},"page":"247-253","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Advances in the management of acute cholecystitis"],"prefix":"10.1002","volume":"3","author":[{"given":"Danny","family":"Mou","sequence":"first","affiliation":[{"name":"Harvard Medical School CRICO Scholar in Quality and Safety Brigham and Women's Hospital  Boston Massachusetts"},{"name":"Department of Surgery Harvard Medical School Brigham and Women\u2019s Hospital  Boston 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