Clinical review of laparoscopic cholecystectomy in acute cholecystitis

Laparoscopic cholecystectomy is the best treatment choice for acute cholecystitis. However, its higher conversion rate and postoperative morbidities remain controversial. The purpose of this retrospective study is to evaluate the clinical significance of laparoscopic cholecystectomy that is performed at our institution in patients with acute cholecystitis.

Between January 2003 and December 2009, a retrospective study was carried out for 190 cases of acute cholecystitis undergoing laparoscopic cholecystectomy at our institution. They were divided into 2 groups, based on the time of operation from the onset of the symptom and other previous abdominal operation history. These groups were compared in the conversion rate and perioperative clinical outcomes, such as sex, age, accompanied disease, operation time, complications, postoperative hospital stay, total hospital stay and total costs.

We compared the two groups based on the timing of laparoscopic cholecystectomy and history of previous abdominal operation. There were no significant differences in the open conversion rate, postoperative complications and postoperative hospital stay, total hospital stay and total costs. The sex ratio, female in the previous abdominal operation group, was larger than the non-previous abdominal operation group (70.2% vs. 43.2%, p=0.003, OR=0.32 [95% CI, 0.15-0.70]). Early operation group was larger than delayed operation group, at previous abdominal operation history (26.1% vs. 13.3%, p=0.026, OR=0.43 [95% CI, 0.20-0.91]) and closed suction drain use (79.3% vs. 66.3%, p=0.044, OR=0.51 [95% CI, 0.27-0.99]).

Although this study was limited, early laparoscopic cholecystectomy for acute cholecystitis with previous abdominal operation history seems to be safe and feasible for patients, having a benefit of decrease in total hospital stay.