Gangrenous cholecystitis: a contemporary review

Area of Science:

• Gastroenterology
• Surgical Innovation
• Patient Outcomes

Background:

• Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis.
• Open cholecystectomy (OC) is often preferred for GC despite laparoscopic cholecystectomy (LC) superiority in other acute cholecystitis cases.
• Characterizing GC outcomes based on surgical approach is crucial.

Purpose of the Study:

• To compare the outcomes of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) for patients diagnosed with gangrenous cholecystitis (GC).
• To evaluate 30-day mortality and complication rates associated with different surgical approaches for GC in the modern era.

Main Methods:

• Analysis of 2005-2011 National Surgical Quality Improvement Project data for patients with GC.
• Propensity score matching to compare outcomes between LC and OC groups.
• Multivariate logistic regression to adjust for patient comorbidities, demographics, and laboratory values.

Main Results:

• A total of 7017 GC patients were identified from 141,970 cholecystectomies.
• LC was associated with a significant decrease in overall 30-day complication rates (OR = 0.46; P < 0.001) compared to OC.
• No significant difference in 30-day mortality was observed between LC and OC for GC patients (OR = 0.59; P = 0.12).

Conclusions:

• Gangrenous cholecystitis (GC) presents higher morbidity and mortality risks than uncomplicated acute cholecystitis.
• Laparoscopic cholecystectomy (LC) is a safe approach for GC, associated with reduced postoperative complications.
• While LC should be prioritized for GC, OC remains a necessary option when patient safety dictates.