[Laparoscopic treatment of acute cholecystitis. Incidence of anatomo-clinical variations (271 cases)]

The study is based on 1050 laparoscopic cholecystectomies for gallstones performed between 1991-1999, out of which 271 were preoperatively considered as acute cholecystitis (25.8%). The clinical, biological and ultrasound criteria were rigorously respected. The preoperative period of 1 to 5 days (mean--2.5) was used for re-equilibration and antibiotic and antithrombotic therapy. The intraoperative criteria were clinical, echolaparoscopical, cholangiographical and bacteriological and established in 219 cases the diagnostic of acute cholecystitis. The final diagnostic, on histopathological basis, confirmed the preoperative diagnosis of acute cholecystitis in 224 cases. The microscopical reexamination in the remainding controversy cases reclassified other 18 as acute cholecystitis (final concordance ratio--242:271). The preoperative overvaluation may be consecutive to a too rapid (before the constitution of specific lesions) or too delayed intervention (the aspect becoming chronical). The elements of diagnostic discordance are raising the problem of case selection and the necessity for standard classification of histological lesions in acute cholecystitis.