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Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in

Stefan Jansen1, Johannes Doerner1, Susanne Macher-Heidrich2

  • 1Department of Surgery II, HELIOS Universitätsklinikum Wuppertal, Witten - Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany.

Surgical Endoscopy
|August 25, 2016
PubMed

Insights

Acute perforated cholecystitis (APC) significantly increases surgical risks, including bile duct injury and conversion rates. Patients with APC face higher morbidity and mortality compared to those without gallbladder perforation.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Hepatobiliary Surgery

Background:

  • Acute perforated cholecystitis (APC) represents the most severe complication of acute cholecystitis.
  • Existing data on cholecystectomy outcomes for APC are limited, often based on small case series.

Purpose of the Study:

  • To investigate the surgical and patient outcomes of cholecystectomy specifically for acute perforated cholecystitis.
  • To identify risk factors and compare outcomes between patients with and without gallbladder perforation.

Main Methods:

  • Analysis of a prospectively maintained quality control database from Germany.
  • Comparison of demographic characteristics, clinical findings, and surgical outcomes between patients with APC and a control group without perforation.

Main Results:

  • Patients with APC (n=5704) showed higher rates of fever, elevated white blood cell count, and positive ultrasound findings compared to controls (n=39,661).
  • Cholecystectomy for APC involved longer surgery duration, increased conversion rates (18.9% vs. 6.8%), higher incidence of bile duct injury (1.4% vs. 0.5%), re-intervention (6.9% vs. 2.9%), and mortality (4.3% vs. 1.3%).
  • APC was associated with a significantly longer hospital stay (13.4 vs. 9.0 days).

Conclusions:

  • Acute perforated cholecystitis is a severe condition associated with increased surgical complexity and risks.
  • Cholecystectomy in APC cases presents higher risks of bile duct injury and conversion, alongside elevated morbidity and mortality rates compared to non-perforated cases.
Abstract

Keywords:
Acute cholecystitisAcute perforated cholecystitisBile duct injuryConversion to open cholecystectomyGallbladder perforationLaparoscopic cholecystectomy

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