["Acute cholecystitis"--laparoscopic cholecystectomy is often possible. Results of a multicenter study by the East German Study Group for Performance Assessment and Quality Assurance in Surgery].
With the introduction of laparoscopic cholecystectomy (LCE) the method became very fast successful in clinical practice. To describe the actual situation we initiated in 1994/95 a clinical multicenter study with the name CESAQ. 29 hospitals participated in the study. 4,675 cholecystectomies were performed, a total number of 2,960 patients were operated upon with the laparoscopic and 1,468 with the conventional technique. Furthermore, conversion to open cholecystectomy was necessary in 247 cases. One part of the study focused on the results achieved for patients with acute cholecystitis. 9.4% of the laparoscopic but 37.3% of the conventional cholecystectomies were performed due to acute cholecystitis. We differentiated a simple (adhesions to gallbladder, hydrops) and complicated form (empyema, gangrenous gallbladder) of acute cholecystitis. Treating acute cases the incidence of intraoperative (simple 8.3%, complicated 12.1%) and specific postoperative complications (simple 9.2%, complicated 6.9%) was higher compared to elective procedures (intraoperative 4.6%, specific postoperative 3.7%). This is well known from the experience of open surgery. Nevertheless there were lower general complication rates (simple 5.5%, complicated 5.2%) and no mortality in acute cholecystitis when LCE was performed. Considering an early conversion to open cholecystectomy in cases of severe acute cholecystitis the indication for LCE can be made generously. Great surgical experience in LCE is a requirement for the laparoscopic management of acute cholecystitis.
Departement für Allgemeine, Viszerale und Kinderchirurgie, Waldklinikum Gera.
M
M
Dietzel
H
H
Lippert
I
I
Gastinger
H
H
Schramm
D000208:Acute Disease; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome