LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS - IS IT REALLY SAFE

The prospectively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed a fter 1 to 3 gears of follow-up. The aim of this study was to compare t he results of laparoscopic cholecystectomy (LC) for acute cholecystiti s with that for routine symptomatic gallbladders. The preoperative, in traoperative, and postoperative parameters of 424 routine (noninflamed ) LCs and 54 LCs for acutely inflamed gallbladders were compared under the ''intention to treat'' principle. Operating time was longer in th e inflamed group (median 97 minutes versus 75 minutes; p < 0.0001). Si gnificantly more adhesions (20% versus 8%), more blood loss (48% versu s 19%), a higher incidence of bile spillage (28% versus 12%), and lost stones (19% versus 8%) were encountered in patients with acute cholec ystitis. Common bile duct (CBD) injuries were also more frequent in th at group (5.5% versus 0.2%; p = 0.005). The rate of conversion to open surgery was higher than with routine LCs (13% versus 4%). There were two deaths in the routine LC group and none in the acutely inflamed gr oup. There was no difference in postoperative pain intensity or postop erative fatigue according to visual analog scale measurements. Patient s with acute cholecystitis stayed only 1 day longer (median 4 days ver sus 3 days) in hospital. The quality of life scores indicate return to almost normal values by the 14th postoperative day. Long-term follow- up (1-3 years) did not reveal any delayed clinical adverse effects. In summary, LC for inflamed gallbladders has a higher conversion rate th an LC for routine symptomatic gallbladders. If successfully performed, it has definite benefit for the patient in terms of better postoperat ive recovery. The trade-off is that the risk of CBD injury is signific antly higher.