Background: In evaluations of laparoscopic cholecystectomy for acute cholecystitis, the role of this technique specifically for empyema of the gall bladder has not been separately addressed. Therefore, we describe the demographic characteristics, clinical and laboratory findings, management and outcome of patients presenting with empyema of the gall bladder who were treated with open cholecystectomy or laparoscopic cholecystectomy. Patients and Methods: Our retrospective evaluation included 1449 patients who underwent cholecystectomy over 88 months, including a 30-month period when open cholecysectomy was the standard operation and a 58-month period when laparoscopic cholecysectomy became the standard operation for acute and chronic cholecystitis. Results: Of the 1449 cholecysectomies, 29 cases proved to have empyema, an incidence of 2%. Males constituted 48.3% of the patients (vs. 22% for the whole cholecystectomy group, P≤0.005) and the average age was 54.6 years (vs. 43 years for the whole cholecystectomy group, P≤0.005). The clinical picture was indistinguishable from other forms of acute cholecystitis. Laparoscopic cholecystectomy was attempted for all the patients in the laparoscopy era with a conversion rate of 42%, significantly higher than other forms of gall bladder diseases (P=0.002). Conclusion: Empyema of the gall bladder is more often encountered in males and the elderly. The clinical picture is indistinguishable from other forms of acute cholecystitis and a preoperative diagnosis is difficult. Early laparoscopic cholecystectomy is advisable for all patients with acute cholecystitis. A higher conversion rate is expected for patients with empyema.

Hemodynamic instability and evisceration should continue to prompt urgent LAP. For stable patients, a sequence of LWE followed by focused abdominal sonography for trauma and computed tomography scanning for unclear cases primed by RCA was found to be efficient in limiting hospital admissions and reducing the rate of non-therapeutic LAP.