ACUTE CHOLECYSTITIS TREATED URGENTLY BY NONSELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

Beginning in 1990, all patients encountered by the author requiring ch olecystectomy were attempted by laparoscopy. This study reports the re sults of 83 patients with acute cholecystitis who were urgently treate d, nonselectively, by laparoscopic cholecystectomy. Acute cholecystiti s was diagnosed clinically by the presence of right upper quadrant per itoneal pain, gallbladder phlegmon and fever, and/or increased white b lood cell count. In addition, a confirming pathology report and/or ele vated white blood cell count was present in all 83 patients. Age range d from 18 to 82 years with an average of 39.4 years. Fifteen patients were male and 68 female. Insufflation was obtained in all patients wit hout a complication. Discharge occurred by postoperative Day one for 2 4 patients, Day two for 66 and by Day three for 75 patients (range 19- 300 hours). No patient had common duct stones. Most patients had stone s impacted in the cystic duct, including one patient who had Mirizzi's syndrome. Operative-time ranged from 28 to 300 minutes, with an avera ge of 106.3 minutes. No conversion to open cholecystectomy was require d. Complications included bile spillage in five patients, stone spilla ge in ten, and ileus in three patients. One patient with Mirizzi's syn drome required a postoperative radiological procedure for removal of a cystic duct stone remnant that was not completely removed at the time of operation. The high complication rate initially associated with la paroscopic cholecystectomy probably resulted from violating cardinal p rinciples of surgery, not from the inappropriateness of laparoscopy. I n conclusion, it is recommended that urgent laparoscopy is an appropri ate initial approach for patients with acute cholecystitis.