Laparoscopic versus open cholecystectomy in acute cholecystitis

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Laparoscopic cholecystectomy is standard for symptomatic gallstones.
• Its application in acute cholecystitis requires safety and efficacy evaluation.

Purpose of the Study:

• To assess the safety and outcomes of laparoscopic cholecystectomy for acute cholecystitis.
• To compare laparoscopic versus open cholecystectomy in this patient group.

Main Methods:

• Comparative study of 146 laparoscopic and 97 open cholecystectomies for acute cholecystitis.
• Analysis of preoperative, operative, and postoperative courses, complications, and conversion rates.

Main Results:

• Successful laparoscopic cholecystectomy showed superior operative/postoperative courses, reduced drain/NG tube use, antibiotics, analgesia, morbidity, and hospital stay.
• Conversion rate was 27%; postoperative course post-conversion was similar to open surgery.
• Complication rates were 16.5% for laparoscopic and 26% for open surgery.

Conclusions:

• Laparoscopic cholecystectomy is safe for selected acute cholecystitis cases with acceptable conversion and low complication rates.
• Predictors for conversion include male sex, older age, large gallstones, nonpalpable gallbladder, and gangrenous cholecystitis.
• Optimal timing for laparoscopic cholecystectomy is within 96 hours of inflammation onset.