Laparoscopic cholecystectomy for acute cholecystitis: the evolving trend in an institution

Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic cholecystolithiasis. Technical maturation and advances in instrumentation have enabled the application of this procedure for acute cholecystitis (AC). We review the evolving role of LC for AC in our institution.

A retrospective study was conducted of patients who received LC for AC between January 1994 and June 2001. Patients' demographics, clinical findings and perioperative outcomes were evaluated.

There were 140 men and 141 women with a mean age of 56.9 years (range, 23-89 years). Two hundred and eighteen of these patients underwent successful LC. There were 63 conversions (22.4%) for uncertain anatomy and difficult dissection (41), gangrenous or perforated gallbladder (16) and bleeding (6). The conversion rates as stratified to surgeon's seniority were 25.1%, 22.8% and 9.7% for registrar, senior registrar and consultant, respectively. The mean operative time was 84.3 minutes (range, 30-255 minutes) and the mean postoperative stay was 5.8 days (range, 1-35 days). The overall complication rate was 11.6%, including two bile duct injuries and two perioperative deaths.

LC for AC is safe and effective and associated with a low incidence of complications when routinely applied by surgical residents. The conversion rate is related to operators' surgical experience.