Laparoscopic cholecystectomy for acute cholecystitis

From October 1991 to March 1994, 35 patients (20 men and 15 women) with acute cholecystitis (AC) underwent laparoscopic cholecystectomy (LC). They ranged in age from 17 to 82 years (mean, 51.7 years). Nine of the 35 patients (25.7%) had either percutaneous transhepatic gallbladder drainage (PTGBD) or percutaneous transhepatic gallbladder aspiration (PTGBA) performed preoperatively. The mean operative time was 183.7 min. Four of the 35 patients (11.4%) required conversion to open laparotomy. The mean postoperative hospital stay was 11.2 days and postoperative morbidity rate was 2.9%. There were no major complications and no deaths. In this retrospective study, we divided the patients into three groups according to the surgical timing of LC in relation to onset. Two of the three groups had LC performed more than 7 days after onset; these groups were termed, collectively, the delayed LC group. The group that had LC performed within 7 days of onset we termed the early LC group. The early LC group had a shorter operative time, less blood loss, and a shorter postoperative hospital stay than the delayed LC group, but the differences were not significant. Nevertheless, we suggest that early LC for AC should be employed for patients who are in a stable condition and who have no preoperative associated medical problems. In the delayed LC group, there were no significant differences in findings between patients who received or did not receive either PTGBD or PTGBA. PTGBD and PTGBA are useful procedures for the relief of acute severe symptoms in patients whose condition is refractory to treatments such as i.v. antibiotic infusion and no oral feeding. We conclude that a laparoscopic procedure for patients with AC, when performed by experienced surgeons, is safe, technically feasible, and useful.