Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis.
OBJECTIVE
To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis.


METHODS
Analysis of data collected prospectively from a consecutive series of 350 laparoscopic operations.


METHODS
Two general surgical units in a teaching hospital.


METHODS
31 patients with a diagnosis of severe acute cholecystitis based on clinical examination, investigation results, and operative findings.


METHODS
Initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation.


METHODS
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.
Wilson
R G
RG
Department of Surgery, Western General Hospital, Edinburgh.
Macintyre
I M
IM
Nixon
S J
SJ
Saunders
J H
JH
Varma
J S
JS
King
P M
PM
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome