Laparoscopic Versus Open Cholecystectomy in Gangrenous Cholecystitis: A Retrospective Comparative Study

Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis associated with increased operative difficulty and postoperative morbidity. Although open cholecystectomy is traditionally preferred, advances in minimally invasive surgery have expanded the role of laparoscopy. However, the optimal surgical approach to GC remains controversial. This study aimed to compare the perioperative and postoperative outcomes of laparoscopic and open cholecystectomy in patients with GC.

This retrospective observational study was conducted at the Department of General Surgery at Deccan College of Medical Sciences, a tertiary care cente in Hyderabad, India. It included adult patients with intraoperatively confirmed GC who underwent laparoscopic or open cholecystectomy at a tertiary care center over a two-year period. Demographic data, operative parameters, intraoperative complications, postoperative morbidity, and length of hospital stay were analyzed and compared between groups.

Seventy-nine patients were included, of which 34 underwent laparoscopic cholecystectomy and 45 underwent open cholecystectomy. Baseline demographic and clinical characteristics were comparable between the groups. The mean operative time was significantly longer in the laparoscopic group (98.5 ± 25.4 min) than in the open group (86.2 ± 22.1 min; p = 0.023). The intraoperative complication rates were similar (p = 0.87). Conversion to open surgery occurred in eight (23.5%) laparoscopic cases. The total number of postoperative complications showed a non-significant reduction following laparoscopic cholecystectomy (p = 0.052), not meeting the predefined threshold for statistical significance (p < 0.05). The median hospital stay was shorter in the laparoscopic group (6 vs. 8 days, p = 0.039).

Laparoscopic cholecystectomy is a safe and feasible option for GC, offering shorter hospital stay despite a longer operative time. A laparoscopic-first approach, with a low threshold for conversion, is recommended for appropriately selected patients.