Gangrenous cholecystitis in the decade before and after the introduction of laparoscopic cholecystectomy.
BACKGROUND
Gangrenous cholecystitis is a severe form of acute cholecystitis with high morbidity. This study investigate the outcomes for patients undergoing cholecystectomy for gangrenous cholecystitis in the decade before and after the introduction of laparoscopic technology at our institution.


METHODS
From 1982 to 2002, all patients undergoing cholecystectomy for gangrenous cholecystitis were prospectively entered into a database. Demographic data, method of surgery, and outcome variables were assessed and compared over time.


RESULTS
Cholecystectomy was performed to treat gangrenous cholecystitis in 238 patients (mean age, 54 years). From 1982 to 1992, 98 patients underwent cholecystectomy for gangrenous cholecystitis, and from 1992 to 2002, 140 patients underwent the procedure. Ninety-seven patients underwent laparoscopic cholecystectomy, and 33 patients (34%) required conversion. The open and laparoscopic cholecystectomy group differed in the number of intensive care unit admissions (13% vs. 5%, P < 0.05), overall length of hospital stay (10 vs. 5.7 days, P < 0.001) and rate of intraabdominal abscesses (8% vs. 0.7%).


CONCLUSIONS
Gangrenous cholecystitis remains a disease with high morbidity. Laparoscopic cholecystectomy shortened hospital stay and can be offered without increasing morbidity. Methods to decrease intraabdominal abscess formation in patients undergoing laparoscopic cholecystectomy for gangrenous cholecystitis are needed.
Department of Surgery, The University of Texas Health Science Center at San Antonio, MC7842, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
Dimitrios
D
Stefanidis
Juliane
J
Bingener
Melanie
M
Richards
Wayne
W
Schwesinger
James
J
Dorman
Kenneth
K
Sirinek
D000368:Aged; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000473:pathology* / Q000601:surgery; D005734:Gangrene; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome