Results of Surgical Treatment for Gallbladder Empyema May Be Analogous to Those of the Remaining Types of Acute Cholecystitis

Abstract

Gallbladder empyema is considered an advanced form of acute cholecystitis with a poor prognosis. In order to analyze the results of surgical treatment for empyema against those obtained with non-empyematous acute cholecystitis, we present a study of 146 cases diagnosed with acute cholecystitis in which early surgery was indicated. At the time of operation the patients were divided into 2 groups, depending on whether or not purulent material was revealed in the gallbladder contents: group I, gallbladder empyema (n = 42), and group II, non-empyematous acute cholecystitis (n = 104). The surgical technique used was similar for both groups (p = NS). Local complications were more frequent in the empyema group (p < 0.01), likewise for infection of the operative wound (p < 0.05). General complications predominated in the non-empyematous cholecystitis group (p < 0.01). Six patients from the 2nd group died, whereas no mortality was recorded in the empyematous cases (p = NS). There were no significant differences with regard to the average hospital stay. Early surgery offers good results in cases of empyema, analogous to those obtained with the remaining cases of non-empyematous acute cholecystitis. Biliary surgery can be performed safely and completely in these patients, and we therefore recommend early surgery for any case of acute cholecystitis as a way of improving the prognosis for empyemas, as one of the advantages.

Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results

“…In a report on open cholecystectomy, gallbladder empyema was significantly associated with a higher rate of local complications when compared with nonempyematous acute cholecystitis [64]. In the technically more demanding laparoscopic cholecystectomy for severe acute cholecystitis a higher rate of local complications was expected too.…”

Robotic cholecystectomy for acute cholecystitis

“…An important consideration is that although gallbladder empyema was significantly associated with a higher rate of local complications when compared with nonempyematous acute cholecystitis, [14] we have successfully treated without complications 2 patients with empyematous acute cholecystitis and 1 with gangrenous cholecystitis.…”