ABSTRACT
BACKGROUND: The laparoscopic cholecystectomy (LC) has been accepted as the procedure of choice for chronic cholecystitis. However in cases of acute cholecystitis, the safety and the efficacy of LC has not been fully determined. Thus we performed this study to assess the clinical outcomes of a LC for acute cholecystitis to evaluate it's efficacy and safety. METHODS: The authors retrospectively analyzed 1,164 LCs performed in Yeungnam University Hospital from May 1991 to March 1996. Among the 1,164 LCs, 118 were performed for acute cholecystitis and 1,046 were performed for chronic cholecystitis. The authors compared the mean operation time, the conversion rate to an open cholecystectomy (OC), the reasons for conversion, the complication rate, the postoperative hospital stay, and the postoperative use of analgesics between the patients with acute cholecystitis and the patients with chronic cholecystitis. RESULTS: In the 1046 patients with chronic cholecystitis, the mean operation time was 55.9 minutes, the conversion rate to an OC was 2.7%, the complication rate was 4.0%, the mean postoperative hospital stay was 3.3 days, and analgesics were used in 48% of the patients. However in the 118 patients with acute cholecystitis, the mean operation time was 65 minutes, the conversion rate to an OC was 11.8%, the complication rate was 16.9%, the mean hospital stay was 4.4 days, and analgesics were used in the 60% of the patients. Also the authors found that the longer duration of preoperative symptoms and an advanced state of inflammation (e.g., GB empyema or gangrenous changes) were the two most common causes of conversion to an OC in the case of acute cholecystitis. Although all the analyzed parameters (especially, the conversion rate and the complication rate) were higher in the patients with acute cholecystitis than they were in the patients with chronic cholecystitis, a LC for acute cholecystitis seems to be acceptable because there were no mortalities and there were no life threatening complications. CONCLUSIONS: From, the aspects of safety and efficacy, a LC can be performed in most patients with acute cholecystitis. However, it should be remembered that the prolonged duration of symptoms prior to a LC increases the conversion rate to O.C. and if we confront the advanced cholecystitis (GB empyem or gangrenous change) with difficult Calot's triangle during a L.C., early conversion to an OC should be considered.