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[Laparoscopic cholecystectomy of acute cholecystitis]
Veselin Stanisić1, Milorad Bakić, Milorad Magdelinić
1Opsta bolnica Berane, Hirursko odeljenje. vesa@cg.rs
Insights
Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis, offering quick recovery and reduced complications. Early conversion to open surgery is recommended when anatomy is unclear to minimize risks.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Context:
- Acute cholecystitis presents challenges for laparoscopic cholecystectomy due to "confused" anatomy and "severe" pathology.
- Despite these challenges, laparoscopic cholecystectomy is increasingly the preferred method for gallbladder disease.
- This study investigates the outcomes of laparoscopic cholecystectomy specifically in acute cholecystitis cases.
Purpose:
- To analyze the outcomes of laparoscopic cholecystectomy in patients with acute cholecystitis.
- To evaluate the feasibility and safety of the laparoscopic approach in this patient group.
- To identify factors influencing operative difficulties and the need for conversion to open surgery.
Summary:
- A prospective analysis of 78 patients with acute calculous cholecystitis was conducted.
- The study found a low rate of operative and postoperative complications, short hospital stays, and rapid recovery.
- Key findings include an average laparoscopic cholecystectomy duration of 58.1 minutes, with a 7.7% conversion rate to open surgery and no lethal outcomes.
Impact:
- Laparoscopic cholecystectomy is demonstrated as an efficient and reliable procedure for acute cholecystitis.
- Identifying preoperative risk factors can aid in patient selection for a smoother surgical process.
- Early conversion to open cholecystectomy is a rational strategy to reduce morbidity in complex cases.
Introduction:
Laparoscopic cholecystectomy is a method of choice for surgical treatment of diseases of gallbladder. Although most surgeons today use laparoscopic cholecystectomy in treatment of severe acute cholecystitis, most surgeons still consider acute cholecystitis a relevant contraindication for laparoscopic cholecystectomy because of "confused" anatomy and "severe" pathology. Aim of the study was to analyze laparoscopic cholecystectomy outcomes in treatment of acute cholecystitis.
Material And Methods:
A prospective analysis included 78 patients operated for acute calculose cholecystitis from Jan 2007 to Dec 2008. We analyzed clinical characteristics of the course of disease, associated diseases, duration of operation, operative and postoperative complications, reasons for conversion into open cholecystectomy.
Results:
The study indicated a low percentage of operative and postoperative complications, short stay in hospital, quick recovery and saving in treatment. The length of preoperative and postoperative hospitalization was 1.4 +/- 0.5 days and 2.5 +/- 1.6 days, respectively. 25 (32%) patients were operated within 72 hours from the onset of symptoms,some operative difficulties were present in 56 (71%) patients, light identification of artery and ductus cysticus in 30 (38.50%) patients, intraoperative lesion of ductus choledohus in 1 (1.3%); in 6 (7.7%) patients conversion into open cholecystectomy was done, the average duration of laparascopic cholecystectomy was 58.1 +/- 26.2 min. There were no lethal outcomes.
Conclusion:
Laparoscopic cholecystectomy is an efficient and reliable operative procedure in treatment of acute cholecystitis. It is much easier to select patients for laparoscopic cholecystectomy when preoperative risk factors predicting difficulties during the operation are known. An early conversion into open cholecystectomy is a rational choice of any surgeon when anatomy is not clear and in cases of advanced inflammatory process in order to decrease operative and postoperative morbidity.
