On-line version ISSN 2078-5151
S. Afr. j. surg. vol.50 n.3 Cape Town Aug. 2012
S BotaitisI; M PitiakoudisI; S PerenteI; G TripsianisII; A PolychronidisIII; C SimopoulosIV
IMD; Second Department of Surgery, Democritus University of Thrace, Greece
IIPhD; Department of Statistics, Democritus University of Thrace, Greece
IIIMD; First Department of Surgery, Democritus University of Thrace, Greece
IVMD; Second Department of Surgery, Democritus University of Thrace, Greece
BACKGROUND AND AIM: Laparoscopic cholecystectomy (LC) is increasingly being used as the initial surgical approach in patients with acute cholecystitis (AC). We describe our experience with LC in the treatment of AC.
MATERIALS AND METHODS: In this study 2 412 patients underwent LC, in 315 cases for AC. The diagnosis was based on clinical, laboratory and intra-operative findings. Rates of conversion, complications, length of hospital stay, operating times, and factors associated with conversion or morbidity were analysed.
RESULTS: Conversion to open cholecystectomy was necessary in 60 patients (19.04%) with AC. Factors associated with conversion were age >65 years, male gender, presence of empyema, previous abdominal surgery, and fever (temperature >37.5°C). There were no deaths, and the complication rate was 6.4%. The only risk factor for morbidity was a bilirubin level of >20.52 µmol/l. The operating time and hospital stay were significantly longer in AC than in elective cases.
CONCLUSIONS: LC for AC is technically demanding but safe and effective. With patience, experience, careful dissection and identification of vital structures, the laparoscopic approach is safe in the majority of cases.
“Full text available only in PDF format”
1. Flowers JL, Bailey RW Scovill WA, Zucker KA. The Baltimore experience with laparoscopic management of acute cholecystitis. Am J Surg 1991;161:388-392. [http:dx.doi.org/10.1016/0002-9610(91)90604] [ Links ]
2. Wilson RG, Macintyre IM, Nixon SJ, Saunders JH, Varma JS, King PM. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ 1992;305:394-396. [ Links ] [Pubmed ID: 1392919]
3. Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: Prospective trial. World J Surg 1997;21:540-545. [http://doi.org/10.1007/PL00012283] [ Links ]
4. Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E. Randomized trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 1998;351:321-325. [http://dx.doi.org/10.1016/s0140-6736(97)08447] [ Links ]
6. Phillips EH, Carroll BJ, Bello JM, Fallas MJ, Daykhovsky L. Laparoscopic cholecystectomy in acute cholecystitis. Am Surg 1992;58:273-276. [ Links ] [PubMed ID: 1535763]
7. Willsher PC, Sanabria JR, Gallinger S, Rossi L, Strasberg S, Litmin DE. Early laparoscopic cholecystectomy for acute cholecystitis: a safe procedure. J Gastrointest Surg 1999;3:50-53. [http://dx.doi.org/10.1016/s1091-255x(99)80008] [ Links ]
8. Fried GM, Barkun JS, Sigman HH, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg 1994;167:35-39. [http://dx.doi.org/10.1016/0002-9610(94)90051-5] [ Links ]
9. Lo CM, Liu CL, Lai ECS, Fan ST, Wong J. Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Ann Surg 1996;223:37-42. [http://doi.org/10.1097/00000658-199601000-00006] [ Links ]
10. Lai PB, Kwong KH, Leung KL, et al. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 1998;85:764-767. [http://doi.org/10.1046/j.1365-2168.1998.00708.x] [ Links ]
12. Bickel A, Rappaport A, Kanievski V, et al. Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 1996;10:1045-1049. [http://doi.org/10.1007/s004649900237] [ Links ]
13. Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation? Arch Surg 1996;131:540-545. [http://doi.org/10.1001/archsurg.1996.01430170086016] [ Links ]
15. Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR. Reasons for conversion from laparoscopic to open cholecystectomy: A 10-year review. J Gastrointest Surg 2002;6:800-805. [http://doi.org/10.1016/s1091-255x(02)00064-1] [ Links ]
16. Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP. Laparoscopic cholecystectomy in acute cholecystitis: A prospective comparative study in patients with acute vs chronic cholecystitis. Surg Endosc 2000;14:358-361. [http://doi.org/10.1007/s004640020088] [ Links ]
19. Lujan JA, Parrilla P, Robles R, et al. Laparoscopic cholecystectomy in the treatment of acute cholecystitis. J Am Coll Surg 1995;181:75-77. [ Links ] [PubMed ID: 7599776]
20. Navez B, Mutter D, Russier Y, et al. Safety of laparoscopic approach for acute cholecystitis: Retrospective study of 609 cases. World J Surg 2001;25:1352-1356. [http://doi.org/10.107/s00268-001-0122-4] [ Links ]
21. el Madani A, Badawy A, Henry C, et al. Laparoscopic cholecystectomy in acute cholecystitis. Chirurgie 1999;124:171-175. [ Links ] [PubMed ID: 10349755]
22. Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 1997;184:571-578. [ Links ] [PubMed ID: 9179112]
23. Suter M, Meyer A. A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis. Is it safe? Surg Endosc 2001;15:1187-1192. [http://doi.org/10.1007/s004640090098] [ Links ]
24. Roslyn JJ, Binns GS, Hughes EFX, Saunders-Kirkwood K, Zinner MJ, Cates JA. Open cholecystectomy: a contemporary analysis of 42,474 patients. Ann Surg 1993;218:129-137. [ Links ] [PubMed ID: 8342992]
25. Chigot JP. Operative risk in cholelithiasis. 5 433 surgical interventions. Sem Hop 1981;57:1311-1319. [ Links ] [PubMed ID: 6269207]