ORIGINAL ARTICLES   

Chirurgia 2005 April;18(2):65-8

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English

Role of laparoscopic cholecystectomy in acute calculus cholecystitis

Pavlidis T. E., Galanis I. N., Grigoriou M. C., Economou B. T., Pavlidis E. T., Atmatzidis K. S.

Aim. Treatment of acute cholecystitis is still under debate. The surgical management of patients presenting with acute cholecystitis remains controversial. The aim of this study was to evaluate the safety and feasibility of urgent laparoscopic cholecystectomy.
Methods. Upon a 4-year period a total of 59 patients (women 58%, mean age 57 years, elderly 34%) underwent laparoscopic cholecystectomy for acute calculus cholecystitis. The diagnosis was made on the basis of clinical examination, laboratory data, modern imaging techniques and histopathological examination. All perioperative data were collected on standardized forms. There were 3 groups of patients in accordance to the last of the episode until operation; group A <3 days (n=22), group B lasting 3-7 days (n=20) and group C >7 days (n=17).
Results. Acute cholecystitis was mild (40.6%), severe with fibrosis (32.2%), mucocele (20.3%), gangrenous (3.4%) and empyema (3.4%). Conversion was necessary in 3 cases (5%) in group C with fistula due to severe inflammation. The mean operating time was 60 min (range 25-120 min). It was longer in group C (85 min) than in group A (46 min) or group B (49 min); likewise, in men (72 min) than in women (51 min). None death or bile duct injury occurred. The morbidity (5%) was seen only in group C and in the elderly. It included biloma (n=2) and persistent sinus (n=1) due to lost gallstones. The mean hospital stay was 3.5 days (range 2-14 days) and return to normal activities 7 days.
Conclusion. Laparoscopic cholecystectomy performed by an experienced surgeon is a safe and effective procedure for the management of acute cholecystitis and its complications; it should be the procedure of choice early in such setting.