LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS

The safety and efficacy of laparoscopic cholecystectomy for acute chol ecystitis were evaluated in a 2-year retrospective review. Results of laparoscopic cholecystectomy in 66 patients with acute inflammation of the gallbladder were compared with those of the standard open procedu re for this condition (43 patients) and routine laparoscopic cholecyst ectomy (227 patients). The laparoscopic procedure for acute cholecysti tis was successful in 46 of 66 patients. There was no difference in me an operating time when the inflamed gallbladder was removed laparoscop ically or at open surgery (82 versus 84 min); however, each procedure took longer than did routine laparoscopic cholecystectomy (mean 69 min ; P<0.01). There was no difference in analgesic requirement between pa tients who underwent laparoscopic removal of an acutely inflamed gallb ladder and those in the other two groups. Postoperative recovery was s ignificantly faster than-that after open surgery (P<0.01), but took lo nger than that following routine laparoscopic cholecystectomy (P<0.01) . Inability to identify the cystic duct was the most common reason for conversion to open operation, which occurred in 20 cases of acute cho lecystitis. Rile duct injury occurred in one of 66 patients with acute cholecystitis treated laparoscopically, two of 227 cases of routine l aparoscopic cholecystectomy but in no patient who underwent open chole cystectomy. In conclusion, laparoscopic cholecystectomy is technically achievable in the majority of patients with acute cholecystitis. The conversion rate is high but, if the procedure is completed successfull y, postoperative recovery is more rapid than that after open surgery. However, the method carries a higher incidence of complications and sh ould be attempted only by experienced surgeons.