Laparoscopic management of acute cholecystitis. Prognostic factors for success.
BACKGROUND
Laparoscopic cholecystectomy for acute cholecystitis is considered feasible and safe, but it is associated with a higher rate of conversion to laparotomy than elective cholecystectomy because of technical reasons and anatomical changes related to the inflammatory process. The value of several factors that might influence its successful completion has not been studied completely yet, including the role of residents in operating such cases under attending-surgeon surveillance.


METHODS
In a retrospective nonrandomized study, the medical charts of 182 patients that were operated for acute cholecystitis (94 of whom via the laparoscopic approach) were studied. The study was also conducted to study the effect of residents as operators.


RESULTS
Male sex, duration of right upper abdominal pain, and the severity of the inflammatory process have all been significantly and independently correlated with increased conversion rate to laparotomy. Operation time was not longer than that of the open approach, and hospital stay and complication rate were lower. Operations performed by residents were associated with twofold conversion rate to laparotomy, without increased complication rate (p < 0.012).


CONCLUSIONS
Laparoscopic management of acute cholecystitis is feasible and safe. Considering the factors discussed above, lowering the threshold for conversion is necessary in selected cases to maintain low morbidity rate. Integrating laparoscopic cholecystectomy for acute cholecystitis into surgical residency should be studied.
Bickel
A
A
Department of Surgery, Western Galilee Hospital, Nahariya, PO Box 21, Israel.
Rappaport
A
A
Kanievski
V
V
Vaksman
I
I
Haj
M
M
Geron
N
N
Eitan
A
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome