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Gangrenous cholecystitis in the laparoscopic era
1Upper Gastrointestinal Unit, St George Hospital, Kogarah, New South Wales, Australia.
The Australian and New Zealand Journal of Surgery
|June 8, 2000
Summary
Laparoscopic cholecystectomies are safe for treating gangrenous cholecystitis (GC), even in older male patients with cardiovascular disease. Preoperative ultrasound is not reliable for diagnosing GC, but laparoscopic surgery offers low conversion and no mortality rates.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- A retrospective review of laparoscopic cholecystectomies performed between 1990 and 1997.
- Focus on identifying characteristics and outcomes associated with gangrenous cholecystitis (GC).
Purpose of the Study:
- To analyze the relationship between gangrenous cholecystitis (GC), acute cholecystitis (AC), and non-acute cholecystectomies (NAC).
- To evaluate patient demographics, risk factors, diagnostic accuracy of ultrasonography, and surgical outcomes in GC.
- To assess the safety and efficacy of laparoscopic cholecystectomy for GC.
Main Methods:
- Prospective data collection from 1304 consecutive patients undergoing laparoscopic cholecystectomies.
- Comparison of patient characteristics (age, sex ratio), comorbidities (cardiac disease, diabetes), ultrasonographic findings (gallbladder wall thickness, CBD diameter), and operative outcomes (conversion rates, complications, mortality) across GC, AC, and NAC groups.
Main Results:
- Twenty-five patients (1.9%) were diagnosed with gangrenous cholecystitis (GC).
- Patients with GC were significantly older (65.4 years) and had a higher male:female ratio (1.5:1) compared to AC and NAC groups (P < 0.05).
- Cardiovascular disease was a significant comorbidity in GC patients. Preoperative ultrasound showed limited accuracy in identifying GC, with a thicker gallbladder wall (4.11 mm) and more dilated CBD (6.1 mm) observed in GC patients.
- The overall conversion rate was 8.7%, with minimal complications and no operative mortality.
Conclusions:
- Gangrenous cholecystitis predominantly affects older males with increased cardiovascular disease incidence.
- Preoperative ultrasonography is unreliable for diagnosing GC.
- Laparoscopic cholecystectomy is a safe and effective treatment for GC, characterized by low conversion rates and no operative mortality.