Laparoscopic management of patients with acute biliary symptoms. Factors predictive of Failure of a laparoscopic technique

ABSTRACT

Laparoscopic cholecystectomy has become the standard elective management of cholelithiasis. Little information exists, however, regarding the appropriateness of this procedure in the setting of acute symptomatology. We reviewed our results with 26 patients with acute biliary symptoms managed laparoscopically. There were 18 females and 8 males with their ages ranging from 22 to 70 years with an average of 46 years. Laparoscopic cholecystectomy was attempted in all patients, and was successful in 22 of 26 patients, four procedures were converted to open cholecystectomy because of difficulty in dissection precluding laparoscopic cholecystectomy. Patients requiring open cholecystectomy were older, more likely to be febrile [mean temperature of 37.9 +/- 0.6 versus 37 +/- 0.7] and were more likely to have a significant leukocytosis [mean white cell Count 12.8 +/- 5.2 +/- 10[3] cells/mm[3] versus 9.2 +/- 2.8 +/- 10[3] cells/mm[3]] than were those undergoing successful laparoscopic cholecystectomy. Laparaoscopic cholecystectomy can be performed safely in the majority of patients presenting with acute biliary symptoms. Patients presenting with a triad of right upper quadrant pain, fever and elevated white cell count who are especially males, elderly and morbidly obese are more likely to require conversion to a standard cholecystectomy and should be informed accordingly