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The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation

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MORTALITY OF URGENCY VERSUS ELECTIVE VIDEOLAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS.

Saulo José Oliveira Felício¹, Ediriomar Peixoto Matos¹, Antonio Maurício Cerqueira¹

¹Bahiana Medical School and Public Health, Salvador, BA, Brazil.

Arquivos Brasileiros De Cirurgia Digestiva : ABCD = Brazilian Archives of Digestive Surgery

|May 11, 2017

Summary

Urgent laparoscopic cholecystectomy for acute cholecystitis shows higher mortality than elective surgery. However, the absolute risk reduction is minimal, suggesting mortality should not heavily influence surgical timing decisions.

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Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Published on: November 25, 2025

Area of Science:

Gastroenterology
Surgical Oncology
Public Health

Background:

The optimal surgical timing for acute cholecystitis remains debated.
Deciding between immediate emergency surgery or delayed elective surgery is a key clinical challenge.

Purpose of the Study:

To evaluate the hypothesis that urgent laparoscopic cholecystectomy for acute cholecystitis leads to increased mortality compared to elective procedures.
To analyze the impact of surgical timing on patient outcomes in acute cholecystitis.

Main Methods:

A retrospective analysis of Brazilian national health data (Datasus) from 2009-2014.
Comparison of mortality rates between elective and urgent laparoscopic cholecystectomy for cholelithiasis.
Calculation of relative risk reduction (RRR), absolute risk reduction, and number needed to treat (NNT).

Main Results:

Elective laparoscopic cholecystectomies constituted 74.6% of the 250,439 procedures performed.
Mortality in the urgent surgery group was 4.8 times higher than in the elective group (0.0023% vs. 0.00048%).
A high relative risk reduction (83%) was observed, but the absolute risk reduction was minimal (0.0018) with an NNT of 55,555.

Conclusions:

While urgent surgery for acute cholecystitis has a higher relative mortality risk, the absolute risk reduction is very small.
The low absolute impact of mortality suggests it should not be the primary factor in deciding surgical timing for acute cholecystitis.