Safety of laparoscopic approach for acute cholecystitis: Retrospective study of 609 cases

Laparoscopic cholecystectomy (LC) is now widely accepted as the modality of choice for the treatment of symptomatic uncomplicated cholelithiasis. The application of the laparoscopic technique in the setting of acute cholecyst itis (AC) is more controversial. The precise role as well as the potential benefits of LC in the treatment of the acutely inflamed gallbladder have no t been clearly established through large clinical series. The aim of our st udy was to assess the feasibility, safety, benefits, and specific complicat ions of the laparoscopic approach in patients with AC. A retrospective char t analysis involving the patients admitted to two busy emergency digestive surgical units between October 1990 and December 1997 was carried out. Six hundred and nine patients meeting our criteria for AC were identified and e valuated. Overall complication rate was 15% with 12 postoperative bile leak ages (1.97%) and 4 biliary tract injuries (BTI) (0.66%). The overall mortal ity rate was 0.66%. Local and overall complication rates were significantly correlated with the delay between the onset of acute symptoms and the oper ation but not the rate of general complications nor deaths. Our results dem onstrate the safety and feasibility of LC in the setting of AC. Early chole cystectomy within 4 days is strongly recommended to minimize complications and increase the chances of a successful laparoscopic approach.