Laparoscopic cholecystectomy in histologically confirmed acute cholecystitis

Forty-four patients with histologically confirmed acute cholecystitis (AC) underwent attempted laparoscopic cholecystectomy (LC) from August 1990 to February 1994 and were retrospectively reviewed. During this time frame, LC was attempted in all patients with AC. Twelve of the patients were scheduled for elective LC as they were not thought to have AC preoperatively. Interestingly, eight of these unsuspected cases of acute cholecystitis had both a normal preoperative white blood cell count and were afebrile. The other 32 patients had a clinical presentation consistent with AC. The only diagnostic finding common to all cases of AC was abdominal pain and tenderness. In addition to AC, five patients also had gallstone pancreatitis, and three others were found to have concomitant choledocholithiasis. Fourteen patients required intraoperative conversion to open cholecystectomy for a laparoscopic success rate of 68%. The most common reason for conversion was difficulty in the dissection or unclear anatomy caused by dense adhesions. LC is an appropriate surgical treatment of AC, provided the surgeon abandons the laparoscopic approach if unable to safely proceed. Diagnostic and admission criteria for AC that requires elevated white blood cell count and/or fever may need revision.