The laparoscopic cholecystectomy. A recommendable indication for acute cholecystitis?

While laparoscopic cholecystectomy has become the procedure of choice for t he elective treatment of symptomatic cholecysrolithiasis the question wheth er patients with acute cholecystitis should be operated laparoscopically or conventionally is still debated. Nevertheless, more and more surgeons tend to use the laparoscopic approach even in patients with acute cholecystitis . Of 1006 laparoscopic cholecystectomies performed at our hospital 42 were done for acute cholecystitis. Conversion to an open procedure was necessary in only one patient because of severe inflammatory changes. The overall mo rtality was zero. The average age was 45.9 years for all patients and 50.4 years for those with acute cholecystitis. The average operating time in pat ients with acute cholecystitis was 81 minutes compared to 62 minutes in pat ients who underwent elective laparoscopic cholecystectomy. The complication rate and the average hospitalization time did not differ significantly bet ween the two groups. Our own data as well as the data retrieved from the li terature seem to indicate that laparoscopic cholecystectomy is superior to the open procedure in the treatment of acute cholecystitis. Prerequisite is that the operation is performed less than 72 hours after the onset of the symptoms by an experienced operating team and the readiness to convert to o pen procedure if procedure if necessary. Under those circumstances laparosc opic cholecystectomy seems to be the treatment of choice for acute cholecys titis.