Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1993 Nov;218(5):630–634. doi: 10.1097/00000658-199321850-00007

Laparoscopic cholecystectomy for acute inflammation of the gallbladder.

M R Cox 1, T G Wilson 1, A J Luck 1, P L Jeans 1, R T Padbury 1, J Toouli 1
PMCID: PMC1243033  PMID: 8239777

Abstract

OBJECTIVE. The aim of this study was to prospectively assess the results of laparoscopic cholecystectomy in patients with acute inflammation of the gallbladder. SUMMARY BACKGROUND DATA. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder disease. Its role in the surgical treatment of acute cholecystitis has not been defined, although a number of recent reports suggest that there should be few contraindications to an initial laparoscopic approach. METHODS. All patients presenting with symptomatic cholelithiasis from October 1990 until June 1992 were evaluated at laparoscopy with intention of proceeding to a laparoscopic cholecystectomy. The gross appearance of the gallbladder was categorized as acute inflammation, chronic inflammation, or no inflammation. Ninety-eight (23.4%) of 418 patients had acute inflammation of the gallbladder: 55 were edematous, 10 were gangrenous, 15 had a mucocele, and 18 had an empyema. RESULTS. The authors assessed outcome in these patients. The frequency of conversion to an open operation was 33.7% for acute inflammation, 21.7% for chronic inflammation (p < 0.05), and 4% for no inflammation (p < 0.001). The conversion rate was highest for empyema (83.3%) and gangrenous cholecystitis (50%), while the conversion rate for edematous cholecystitis was 21.8% and for acute inflammation with a mucocele it was 7%. The median operation time for successful laparoscopic cholecystectomy for acute inflammation was 105 minutes, which was longer than that with no inflammation (90 minutes). However, the incidence of complications was not different from that for chronic or no inflammation. The median postoperative stay for patients with acute gallbladder inflammation was 2 days for successful laparoscopic cholecystectomy and 7 days for patients converted to an open operation. CONCLUSIONS. Laparoscopic cholecystectomy for acute inflammation of the gallbladder is safe and is associated with a significantly shorter postoperative stay compared to open surgery. A greater number of patients required conversion to open operation compared to those with no obvious inflammation. Conversion to open operation was most frequent for empyema and gangrenous cholecystitis, suggesting that once this diagnosis is made, excessive time should not be spent in laparoscopic trial dissection before converting to an open operation.

Full text

PDF
631

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Addison N. V., Finan P. J. Urgent and early cholecystectomy for acute gallbladder disease. Br J Surg. 1988 Feb;75(2):141–143. doi: 10.1002/bjs.1800750217. [DOI] [PubMed] [Google Scholar]
  2. Cox M. R., Gunn I. F., Eastman M. C., Hunt R. F., Heinz A. W. Open cholecystectomy: a control group for comparison with laparoscopic cholecystectomy. Aust N Z J Surg. 1992 Oct;62(10):795–801. doi: 10.1111/j.1445-2197.1992.tb06921.x. [DOI] [PubMed] [Google Scholar]
  3. Cuschieri A., Dubois F., Mouiel J., Mouret P., Becker H., Buess G., Trede M., Troidl H. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991 Mar;161(3):385–387. doi: 10.1016/0002-9610(91)90603-b. [DOI] [PubMed] [Google Scholar]
  4. Fielding G. A. Laparoscopic cholecystectomy. Aust N Z J Surg. 1992 Mar;62(3):181–187. doi: 10.1111/j.1445-2197.1992.tb05459.x. [DOI] [PubMed] [Google Scholar]
  5. Flowers J. L., Bailey R. W., Scovill W. A., Zucker K. A. The Baltimore experience with laparoscopic management of acute cholecystitis. Am J Surg. 1991 Mar;161(3):388–392. doi: 10.1016/0002-9610(91)90604-c. [DOI] [PubMed] [Google Scholar]
  6. Ganey J. B., Johnson P. A., Jr, Prillaman P. E., McSwain G. R. Cholecystectomy: clinical experience with a large series. Am J Surg. 1986 Mar;151(3):352–357. doi: 10.1016/0002-9610(86)90466-6. [DOI] [PubMed] [Google Scholar]
  7. Gilliland T. M., Traverso L. W. Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. Surg Gynecol Obstet. 1990 Jan;170(1):39–44. [PubMed] [Google Scholar]
  8. Gingrich R. A., Awe W. C., Boyden A. M., Peterson C. G. Cholecystostomy in acute cholecystitis. Factors influencing morbidity and mortality. Am J Surg. 1968 Aug;116(2):310–315. doi: 10.1016/0002-9610(68)90509-6. [DOI] [PubMed] [Google Scholar]
  9. Goodman G. R., Hunter J. G. Results of laparoscopic cholecystectomy in a university hospital. Am J Surg. 1991 Dec;162(6):576–579. doi: 10.1016/0002-9610(91)90112-q. [DOI] [PubMed] [Google Scholar]
  10. Graves H. A., Jr, Ballinger J. F., Anderson W. J. Appraisal of laparoscopic cholecystectomy. Ann Surg. 1991 Jun;213(6):655–664. doi: 10.1097/00000658-199106000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hugh T. B., Chen F. C., Hugh T. J., Li B. Laparoscopic cholecystectomy. A prospective study of outcome in 100 unselected patients. Med J Aust. 1992 Mar 2;156(5):318–320. doi: 10.5694/j.1326-5377.1992.tb139786.x. [DOI] [PubMed] [Google Scholar]
  12. Jacobs M., Verdeja J. C., Goldstein H. S. Laparoscopic cholecystectomy in acute cholecystitis. J Laparoendosc Surg. 1991 Jun;1(3):175–177. doi: 10.1089/lps.1991.1.175. [DOI] [PubMed] [Google Scholar]
  13. Järvinen H. J., Hästbacka J. Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg. 1980 Apr;191(4):501–505. doi: 10.1097/00000658-198004000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Larson G. M., Vitale G. C., Casey J., Evans J. S., Gilliam G., Heuser L., McGee G., Rao M., Scherm M. J., Voyles C. R. Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients. Am J Surg. 1992 Feb;163(2):221–226. doi: 10.1016/0002-9610(92)90105-z. [DOI] [PubMed] [Google Scholar]
  15. McArthur P., Cuschieri A., Sells R. A., Shields R. Controlled clinical trial comparing early with interval cholecystectomy for acute cholecystitis. Br J Surg. 1975 Oct;62(10):850–852. doi: 10.1002/bjs.1800621025. [DOI] [PubMed] [Google Scholar]
  16. Norrby S., Herlin P., Holmin T., Sjödahl R., Tagesson C. Early or delayed cholecystectomy in acute cholecystitis? A clinical trial. Br J Surg. 1983 Mar;70(3):163–165. doi: 10.1002/bjs.1800700309. [DOI] [PubMed] [Google Scholar]
  17. Nottle P. D. Percutaneous laparoscopic cholecystectomy: indications, contraindications and complications. Aust N Z J Surg. 1992 Mar;62(3):188–192. doi: 10.1111/j.1445-2197.1992.tb05460.x. [DOI] [PubMed] [Google Scholar]
  18. Peters J. H., Ellison E. C., Innes J. T., Liss J. L., Nichols K. E., Lomano J. M., Roby S. R., Front M. E., Carey L. C. Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg. 1991 Jan;213(1):3–12. doi: 10.1097/00000658-199101000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Peters J. H., Gibbons G. D., Innes J. T., Nichols K. E., Front M. E., Roby S. R., Ellison E. C. Complications of laparoscopic cholecystectomy. Surgery. 1991 Oct;110(4):769–778. [PubMed] [Google Scholar]
  20. Reddick E. J., Olsen D., Spaw A., Baird D., Asbun H., O'Reilly M., Fisher K., Saye W. Safe performance of difficult laparoscopic cholecystectomies. Am J Surg. 1991 Mar;161(3):377–381. doi: 10.1016/0002-9610(91)90601-9. [DOI] [PubMed] [Google Scholar]
  21. Schirmer B. D., Edge S. B., Dix J., Hyser M. J., Hanks J. B., Jones R. S. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991 Jun;213(6):665–677. doi: 10.1097/00000658-199106000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES