[Laparoscopic treatment of acute cholecystitis]

Acute cholecystitis has been considered a contraindication for laparoscopic cholecystectomy after its affirmation as the golden standard for treatment of chronic cholecystitis. However, over time it has been proven that acute cholecystitis could also be managed laparoscopically, although it was technically demanding procedure, burdened with relatively high conversion rates. In this study we present our series of 26 patients, urgently admitted for acute cholecystitis. They are presented with clinical findings typical for acute cholecystitis. The diagnosis was determined using ultrasound examination, and confirmed postoperatively by pathohistological findings. In all 26 cases we managed to perform laparoscopic cholecystectomy, there were no conversion. Mean operative time was 73 +/- 21 minutes. Postoperatively, we haven't recorded any significant complications. Mean hospital stay was 4.8 +/- 2.5 days. Even though laparoscopic treatment of acute cholecystitis is technically more demanding and lengthier procedure than laparoscopic treatment of chronic cholecystitis, we consider acute cholecystitis to be a laparoscopically manageable disease. During the operation, tissue edema and hyperemia presented main technical challenge. They presented a significantly greater problem if the symptoms lasted for more than 3 days prior to operation. Therefore we suggest that laparoscopic cholecystectomy should be carried out in the first 72 hours after the onset of symptoms, since any further delay will lead to development of tissue hyperemia and edema, thus making the operation technically more demanding.