Laparoscopic cholecystectomy in acute cholecystitis

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Acute cholecystitis presents with variable clinical signs, including abdominal tenderness, leukocytosis, and fever.
• A significant proportion of patients present with only one or two of these classic symptoms.
• Laparoscopic cholecystectomy is increasingly adopted for gallbladder disease.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic cholecystectomy in patients diagnosed with acute cholecystitis.
• To assess the incidence of common bile duct stones in this patient cohort.
• To determine the correlation between clinical presentation and surgical outcomes.

Main Methods:

• A prospective study of 25 patients with acute cholecystitis undergoing laparoscopic cholecystectomy between August 1989 and December 1990.
• Detailed recording of preoperative clinical signs, operative findings, and postoperative outcomes.
• Routine intraoperative cholangiography performed on all patients.

Main Results:

• 84% of patients had abdominal tenderness, 64% leukocytosis, and 40% fever; 44% presented with a single sign.
• Average operative time was 119 minutes, correlating with the number of clinical signs.
• 4 patients (16%) had common bile duct stones; average hospitalization was 3.8 days with a 2-week return to activity.
• Low complication rate, including 3 wound infections and 2 hyperamylasemia, with no mortality or intra-abdominal abscesses.

Conclusions:

• Laparoscopic cholecystectomy for acute cholecystitis is technically demanding but safe with adequate surgical expertise.
• Routine intraoperative cholangiography is essential due to a higher incidence of common bile duct stones compared to elective procedures.
• The procedure offers a favorable recovery profile, with patients returning to normal activities within two weeks.