Early Laparoscopic Cholecystectomy for Acute Gangrenous Cholecystitis

Abstract

Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications and conversion to open cholecystectomy. We investigated whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. Pathologic diagnoses and outcomes were analyzed in patients who underwent laparoscopic or open cholecystectomy at our hospital, January 2002 to September 2005. Of 30 patients with acute gangrenous cholecystitis, 16 underwent early laparoscopic cholecystectomy, 10 underwent open cholecystectomy, and 4 were converted to open cholecystectomy (conversion rate, 20.0%). There was no significant difference in operation time or intraoperative bleeding. The requirement for postoperative analgesics was significantly lower (6.4+/-7.3 vs. 1.5+/-1.2 doses, P<0.05) and hospital stay significantly shorter (8.6+/-2.1 vs. 15.6+/-6.3 d, P<0.01) after laparoscopic cholecystectomy. There were no postoperative complications in either group. Thus, early laparoscopic cholecystectomy seems appropriate for acute gangrenous cholecystitis. Conversion to open cholecystectomy may be required in difficult cases with complications.

Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

“…7,13,16,22 In our present cases, postoperative stay was similar or shorter than other reports; 3.7 days in group 2. In group 2, there was significant correlation among postoperative stay, age, and ASA class.…”

“…However, technical advances and increased experience have gradually led surgeons to attempt laparoscopic surgery in cases of acute gangrenous cholecystitis. 7,15,16 Tsushimi et al 22 reported that there were no postoperative complications. Thus, early laparoscopic cholecystectomy seems to be appropriate for acute gangrenous cholecystitis.…”

Impact of Delayed Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage for Patients With Complicated Acute Cholecystitis

“…[15][16][17][18] In our study, LCs in group 1 were performed at a mean of 6.1 days (range, 0 to 18 d) after admission. Tsushimi et al 25 reported appropriateness of early LC for acute gangrenous cholecystitis with a relatively high conversion rate (20.0%). However, there are no previous large-scale studies on LC for complicated severe acute cholecystitis according to the timing of the LC.…”

Laparoscopic cholecystectomy for acute cholecystitis

“…We believe that a low threshold for conversion is important to minimize the risk of major complications. [11] 6/44 (13.6%) 18/24 (75%) Kum [16] 7/54 (13%) Cox [17] 33/98 (33.7%) 21.8% 50% 83.3% Bingener [18] 33/97 (34%) Habib [19] 14/44 (32%) Suter [20] 15.6% Tsushimi [21] 4/20 (20%) Araujo-Teixeira [22] 24/100 (24%) Koperna [23] 44 Lo et al [13] advocated an early decision for conversion of LC to open procedure for the treatment of AC. We consider that the surgeon should never hesitate to convert, should make an early decision for it within 15 to 20 min on average, and not persist with a difficult dissection.…”