The applicability of micro- and minilaparotomy in the management of obstructive cholecystitis

There are conflicting opinions concerning the management of acute cholecystitis, with particular reference to the optimal time for surgical intervention in the course of minimally access surgery. The present study was undertaken to elucidate the applicability of micro- and modern minilaparotomy in the management of obstructive cholecystitis and to ascertain the optimum time for surgical intervention. A total of 607 consecutive cholecystectomies were performed by micro- and modern minilaparotomy between 11 December, 1990 and 11 December, 1993 at our department: 202 (33.3%) with obstructive cholecystitis. The patients were divided into five groups on the basis of time passing from the onset of the acute symptoms to surgery. Comparing the data of the first 3 groups to the 4th and 5th groups, data demonstrate that those operations which were done up to 10 days following the onset of acute cholecystitis were technically difficult in 16% of the patients. However, the technical difficulties increased up to 56% (group 4) and 59% (group 5) by the delay of surgical intervention to more than ten days or six weeks after the onset of the acute symptoms of obstructive cholecystitis.