Analysis of the Management of Acute Cholecystitis in the Laparoscopic Era

ABSTRACT

Laparoscopic surgery is now a commonly used procedure for biliary tract disease because of the small incision, the shorter hospital stay, lower postoperative pains, and prompt recovery. Acute or subacute cholecystitis has been considered a contraindication because the procedure becomes time consuming and complicated. However, improvements in surgical technique and development of better surgical equipment has lead to interest in the use of laparoscopy for acute cholecystitis. However, the proper timing for the operation is still questionable. The authors analyzed 28 cases of laparoscopic cholecystectomies performed for acute cholecystitis between January 1992 and first half of 1997 in order to determine the clinical significant of using a laparoscopic cholecystectomy for patients with acute cholecystitis. For all 28 cases of histopathologically confirmed acute cholecystitis, we analyzed the of surgical method, mean hospital stay, mean operating time, and postoperative analgesic requirement. Each subjects were also analysed year by yearly to determine laparoscopic cholecystectomy for acute cholecystitis. As to histopathologic type, 81% were calculous cholecystitis, and 19% were acalculous cholecystitis. Empyema cases accounted for 46% of the total number of cases. During the 1992, all cases was treated by using a gas technique, but in 1995, the gas technique was used in only 60% of the cases. In 1996, a gasless technique surpassed gas technique was used in 57.2% of the cases. In 1997, all cases were treated by using a gasless technique. The mean hospital stay gradually decreased through the years from 6.75 days in '92, to 5.85 days in '95, 5.8 days in '96 and 5 days in '97. The mean operation time also showed a decrease from 100 min in '92, to 139 min. in '95, 104.64 min in '96 and 90 min in '97. A postoperative analgesic was used 1.5 times in '95, 1.14 times in '95, 1 time in '96 and 0.8 time in '97. In conclusion, the laparoscopic approach to treating acute cholecystitis has reduced the hospital stay, and the mean operation time due to the use of a gasless technique and to development of better laparoscopic instruments. Also, the use of the gasless technique is more treat cost effectiveness, so, the gasless laparoscopic technique is becoming popular as a way to acute cholecystitis in the laparoscopic era.