Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

Abstract

The aim of this study was to evaluate the surgical outcomes of laparoscopic cholecystectomy (LC) in patients who were diagnosed with severe acute cholecystitis (SAC) and to clarify the useful treatment modalities of SAC. Of 112 patients who presented SAC, we selected 99 patients and divided them into 3 groups: 37 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD; group 1), 62 patients with SAC but not indicated for PTGBD (group 2), and 59 patients with acute and chronic cholecystitis (group 3). The conversion rate was 2.7% (1/37) in group 1, 6.5% (4/62) in group 2, and 1.7% (1/59) in group 3. In groups 1 and 2, the postoperative stay and operative time were longer than those in group 3 with significant difference, respectively (P<0.05). In group 2, there was correlation not only between postoperative stay and age but also between postoperative stay and ASA class (P<0.05). In group 2, there was no correlation between time to operation and operative time and also between time to operation and postoperative stay, however, there was surprisingly significant correlation between time to operation and conversion rate in SAC (P=0.018). In conclusion, PTGBD should selectively be performed in patients with severe comorbidities rather than improving surgical outcomes of LC for severe acute cholecystitis. If patients are not indicated for PTGBD, an early laparoscopic cholecystectomy is recommended because it can decrease conversion rate, although it cannot decrease operative time and postoperative stay.

Percutaneous cholecystostomy for acute cholecystitis in high‐risk elderly patients

“…However, older age and higher comorbidities were found in the PC group. Another study showed that PC had a shorter operation time and shorter postoperative hospital stay than emergency cholecystectomy [20]. In our study, the mortality rate was higher in the elderly group but was not statistically significant.…”

Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

“…The mortality rate was significantly higher in the primary open approach but not in the converted group. Practically, AC remains a severe and potentially lethal disease [27,29], especially in elderly and high-risk patients.…”

Operative Timing of Laparoscopic Cholecystectomy for Acute Cholecystitis in a Japanese Institute

“…24 In addition, PTGBD may not increase postoperative infectious complications after LC, according to results of our study and published papers. 25,26 It is still unclear whether PTGBD before LC improves surgical outcomes, although several reports have already been published to support its effectiveness. 26–28 …”