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Laparoscopic surgery in very acute cholecystitis
Paolo Ubiali1, Rocco Invernizzi, Francesco Prezzati
1General Surgical Unit, Alzano Lombardo Hospital, Bg, Italy. paolaparo@tiscalinet.it
Insights
Laparoscopic cholecystectomy is safe and feasible for treating severe gallbladder infections like empyematous or gangrenous cholecystitis. This minimally invasive approach offers low morbidity and short hospital stays for acute cases.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Empyematous and gangrenous cholecystitis represent severe gallbladder inflammation.
- Traditional treatment often involves open surgery, which can be more invasive.
Purpose of the Study:
- To assess the safety and feasibility of laparoscopic cholecystectomy for patients with empyematous or gangrenous cholecystitis.
- To evaluate outcomes in a consecutive series of patients undergoing this procedure.
Main Methods:
- A prospective study of 64 patients diagnosed with empyematous or gangrenous cholecystitis between August 1998 and April 2000.
- Diagnosis was based on clinical, echographic, and intraoperative findings.
- All procedures were performed by experienced laparoscopic surgeons.
Main Results:
- Successful laparoscopic cholecystectomy was achieved in 59 out of 64 patients (92.2%).
- Five conversions to open surgery were necessary due to adhesions, anatomical challenges, or fistula.
- The study reported no mortality and very low morbidity, with a short hospital stay.
Conclusions:
- Laparoscopic cholecystectomy is a safe and feasible option for managing acute cholecystitis, including severe forms like empyematous and gangrenous cases.
- Experienced surgeons can successfully perform this procedure with favorable outcomes.
- Patients with very acute cholecystitis are suitable candidates for a laparoscopic approach.
Abstract:
The objective of this study was to demonstrate the safety and feasibility of laparoscopic cholecystectomy in empyematous or gangrenous cholecystitis. During the period from August 1998 to April 2000, we operated laparoscopically on 64 patients, without any selection, in which we established, preoperatively or intraoperatively, the diagnosis of empyematous or gangrenous cholecystitis using clinical criteria (fever, leukocytosis, persistent pain, abdominal tenderness or guarding), echographic findings and intraoperative or pathological aspects of the gallbladder. The operations were performed by experienced surgeons skillful in advanced laparoscopic procedure. We concluded successfully 59 operations. The five conversions were due to dense adhesions because of previous gastric surgery in 3 cases, to the lack of recognizing the anatomy of the biliary tree in one case and to a choledoco-duodenal fistula in the last case. No mortality and a very low morbidity with a short hospital stay, were noted in our study. We consider patients with very acute cholecystitis to be candidates for a laparoscopic approach.