Open and laparoscopic cholecystectomy in acquired immunodeficiency syndrome: Indications and results in fifty-three patients

Background. Although acute cholecystitis is one of the most common indicati ons for abdominal surgery in patients with acquired immunodeficiency syndro me (AIDS), previous studies have reported disappointingly high morbidity an d mortality among those patients who have undergone cholecystectomy. The ai ms of this study were to analyze the indications for and the outcome of cho lecystectomy performed for acute cholecystitis in patients with AIDS. Methods. We retrospectively reviewed the hospital charts of 53 patients wit h AIDS who underwent open or laparoscopic cholecystectomy from 1992 to 1997 . Statistical analysis using the chi-square, Student's t, and Fisher exact tests was conducted to determine whether cause of cholecystitis, type of su rgical approach, and CD4+ T-lymphocyte count influenced outcome. Results. The clinical findings and imaging by ultrasonography were always r eliable in establishing diagnosis and guiding treatment of acute cholecysti tis. Open cholecystectomy was performed in 24 patients (45%). The procedure was begun laparoscopically in 29 patients (55%) and converted to open in 4 (14%). The pathologic findings showed acalculous cholecystitis in 19 patie nts (36%) and cholelithiasis in 32 (60%). Morbidity was 34% and mortality w as 2%. Type of operative approach, cause of cholecystitis, and CD4+ T-lymph ocyte count (greater or less than 50 cells/mm(3)) did not significantly aff ect morbidity and mortality. The length of hospital stay was significantly influenced by the CD4+ T-lymphocyte count. Conclusions. These findings suggest that in most patients with AIDS, laparo scopic or open cholecystectomy may be performed with significant but accept able morbidity and low mortality.