Introduction
The standard treatment for symptomatic cholecystitis associated with gallstones is cholecystectomy. Laparoscopic cholecystectomy (LC) has replaced conventional open cholecystectomy and has become the gold standard of treatment for acute cholecystitis (AC). In recent years, laparoscopic surgery has been confirmed to be preferable to open surgery in elective cholecystectomy cases. Open cholecystectomy (OC) used to be preferred because of the technical difficulties and the high complication rates associated with LC. However, several studies have shown that LC is safe and can be recommended as a form of cholecystectomy. Moreover, in treatment of AC (that comprises 20% of gallbladder disease), LC has become the gold standard procedure. Many studies have demonstrated the safety of LC used to treat acute cholecystitis within 72 h of attack. It remains true that, in cases of acute cholecystitis, the complication rate of laparoscopic surgery and the rate of conversion to open surgery remain higher than those of cases of chronic cholecystitis.
Aim
The aim of this study was to prospectively assess the outcome of early laparoscopic cholecystectomy (LC) in patients with acute cholecystitis.
Materials and methods
Between July 2005 and December 2012, of 623 patients who had symptoms of acute cholecystitis during the first 72 h of hospital admission and who did not respond to non-operative treatment, 302 underwent surgical treatment. After initial treatment, all patients were followed up for 21 months on average (range: 5-27 months). The clinical, biochemical, radiological, and operative data of the 302 consecutive patients with acute cholecystitis were recorded and analyzed prospectively.
Results
Of the 302 patients who underwent LC for acute cholecystitis, 169 were females and 133 males. Their mean ages were 47.8 years (range: 17-79 years) and 53.3 years (range: 27-90 years) respectively. Conversion to open surgery was required in 32 patients (10.5%). The mean postoperative length of hospital stay was 2 days (range: 1-3 days) in the LC group and 3 days (range: 2-6 days) in the conversion group. Significant differences between the successful LC group and the conversion group were evident terms of the length of postoperative hospitalization and gallbladder wall thickness (P=0.023). Factors associated with conversion were male gender, pericholecystic collection observed via ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. We experienced two minor bile duct injury complications that were treated via T tube placement. No mortality occurred. Ten patients suffered infections at the incisional locations, and eight patients developed lung infections.
Conclusion
Early LC is safe in patients with acute cholecystitis. Male gender, pericholecystic collection determined via ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.