LAPAROSCOPIC CHOLECYSTOSTOMY WITH DELAYED CHOLECYSTECTOMY AS AN ALTERNATIVE TO CONVERSION TO OPEN PROCEDURE

Background: Acute cholecystitis carries the highest incidence of conve rsion from planned laparoscopic cholecystectomy to open surgery due to unclear anatomy, excessive bleeding, complications, or other technica l reasons. Methods: Laparoscopic tube cholecystostomy was performed in stead of immediate conversion to laparotomy in 9 patients with acute c holecystitis after unsuccessful attempts at laparoscopic dissection. E lective laparoscopic cholecystectomy was done 3 months later. Results: Following this approach eight patients were treated successfully. Aft er 3 months the acute process had subsided sufficiently to allow a saf e laparoscopic cholecystectomy. One additional patient died of acute l eukemia 6 weeks after cholecystostomy. Before adopting this technique we subjected 171 patients with acute calculous cholecystitis to laparo scopic cholecystectomy; there was an 11% (19 cases) rate of conversion . Since cholecystostomy has begun to be offered as an alternative to c onversion, 121 patients with acute cholecystitis have had laparoscopic cholecystectomy and only 2 cases (1.5%) have been converted to immedi ate open cholecystectomy. Conclusions: We recommend the alternative of performing a cholecystostomy with delayed laparoscopic cholecystectom y instead of conversion to open procedure when facing a case of acute cholecystitis not amenable to laparoscopic cholecystectomy.