Difficult cholecystectomies: validity of the laparoscopic approach.
OBJECTIVE
The aim of this work was to determine the outcome of "difficult cholecystectomy" caused by acute cholecystitis or cirrhosis, in relation to the number of conversions, principal biliary duct injuries, the length of the operation, and of postoperative hospitalization.


METHODS
From 1998 through 2000, 51 patients, 38 females and 13 males, underwent cholecystectomy for acute cholecystitis and cholecystitis associated with liver cirrhosis; the average age was 58.8 years (range, 24 to 86 years). No preoperative selection was made for video laparoscopic treatment. An open laparoscopy was performed in all cases.


RESULTS
All interventions were completed by video laparoscopy. No injury of the major bile ducts occurred in the 51 cases. The average time of operation was 110 minutes. The average length of hospitalization was 3 days.


CONCLUSIONS
This study demonstrates that the results after "difficult laparoscopic cholecystectomy" are comparable to those after "open cholecystectomy." Difficult cholecystectomy executed with video laparoscopic methodology is safe and effective if performed with appropriate equipment and by experienced surgeons.
Neri
Vincenzo
V
University of Foggia, Division of General Surgery, Ospedali Riuniti Hospital, Foggia, Italy. tizpv@tiscali.it
Ambrosi
Antonio
A
Di Lauro
Giuseppe
G
Fersini
Alberto
A
Valentino
Tiziano Pio
TP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D016896:Treatment Outcome