Abstract
OBJECTIVE--To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis. DESIGN--Analysis of data collected prospectively from a consecutive series of 350 laparoscopic operations. SETTING--Two general surgical units in a teaching hospital. SUBJECTS--31 patients with a diagnosis of severe acute cholecystitis based on clinical examination, investigation results, and operative findings. INTERVENTIONS--Initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation. MAIN OUTCOME MEASURES--Failure to complete the operation laparoscopically, length of postoperative stay in hospital, early postoperative morbidity, interval from operation to full activity, and return to work. RESULTS--Laparoscopic cholecystectomy was attempted in 19 patients with empyema of the gall bladder and 12 who had severe cholecystitis which failed to settle on medical management. A total of 29 operations were successfully completed with two conversions to open surgery. Two minor postoperative complications occurred, and one case of retained common bile duct stones with jaundice was treated by endoscopic retrograde cholangiopancreatography and papillotomy. Median postoperative hospital stay was two days, with return to normal activity in seven days and to work in two weeks. There were no deaths related to the operation. CONCLUSIONS--In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cooperman A. M. Laparoscopic cholecystectomy for severe acute, embedded, and gangrenous cholecystitis. J Laparoendosc Surg. 1990;1(1):37–40. doi: 10.1089/lps.1990.1.37. [DOI] [PubMed] [Google Scholar]
- 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]
- Dubois F., Icard P., Berthelot G., Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990 Jan;211(1):60–62. doi: 10.1097/00000658-199001000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Holohan T. V. Laparoscopic cholecystectomy. Lancet. 1991 Sep 28;338(8770):801–803. doi: 10.1016/0140-6736(91)90678-i. [DOI] [PubMed] [Google Scholar]
- 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]
- Reiss R., Nudelman I., Gutman C., Deutsch A. A. Changing trends in surgery for acute cholecystitis. World J Surg. 1990 Sep-Oct;14(5):567–571. doi: 10.1007/BF01658790. [DOI] [PubMed] [Google Scholar]
- Unger S. W., Edelman D. S., Scott J. S., Unger H. M. Laparoscopic treatment of acute cholecystitis. Surg Laparosc Endosc. 1991 Mar;1(1):14–16. [PubMed] [Google Scholar]
- Wilson P., Leese T., Morgan W. P., Kelly J. F., Brigg J. K. Elective laparoscopic cholecystectomy for "all-comers". Lancet. 1991 Sep 28;338(8770):795–797. doi: 10.1016/0140-6736(91)90674-e. [DOI] [PubMed] [Google Scholar]
- Zucker K. A., Bailey R. W., Gadacz T. R., Imbembo A. L. Laparoscopic guided cholecystectomy. Am J Surg. 1991 Jan;161(1):36–44. doi: 10.1016/0002-9610(91)90358-k. [DOI] [PubMed] [Google Scholar]