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Laparoscopic cholecystectomy for acute cholecystitis: prospective trial
World Journal of Surgery
|June 1, 1997
Summary
Laparoscopic cholecystectomy (LC) for acute cholecystitis is safe with low rates of conversion and complications when performed within 96 hours. Factors like gangrenous cholecystitis and patient age predict conversion, while male gender and bilirubin levels predict complications.
Area of Science:
- Surgical Gastroenterology
- Minimally Invasive Surgery
- Biliary Tract Surgery
Background:
- Laparoscopic cholecystectomy (LC) is the standard for elective gallstone disease.
- Its application in acute cholecystitis presents challenges, influencing conversion and complication rates.
- Understanding factors affecting LC outcomes in acute cholecystitis is crucial.
Purpose of the Study:
- To determine indications and optimal timing for LC in acute cholecystitis.
- To evaluate factors predicting conversion from LC to open cholecystectomy.
- To assess factors associated with complications during LC for acute cholecystitis.
Main Methods:
- Prospective study of 130 patients with acute cholecystitis undergoing LC.
- Data collected on preoperative, operative, and postoperative factors.
- Analysis of conversion and complication rates based on cholecystitis severity and operative delay.
Main Results:
- Overall conversion rate was 28% (37/130); gangrenous cholecystitis had a significantly higher conversion rate (49%) than uncomplicated cases (4.5%).
- Delay >96 hours increased conversion rate (47% vs 23%).
- Complication rates were 8.5% in the successful LC group and 27% in the converted group. Age >65, gangrenous cholecystitis, and high WBC predicted conversion.
Conclusions:
- LC is generally safe for acute cholecystitis with acceptable outcomes if performed within 96 hours.
- Severity of cholecystitis and operative delay significantly impact conversion rates.
- Identifying predictors of conversion and complications aids in planning laparoscopic management.