title: Early laparoscopic cholecystectomy for acute gangrenous cholecystitis.
abstract: Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications and conversion to open cholecystectomy. We investigated whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. Pathologic diagnoses and outcomes were analyzed in patients who underwent laparoscopic or open cholecystectomy at our hospital, January 2002 to September 2005. Of 30 patients with acute gangrenous cholecystitis, 16 underwent early laparoscopic cholecystectomy, 10 underwent open cholecystectomy, and 4 were converted to open cholecystectomy (conversion rate, 20.0%). There was no significant difference in operation time or intraoperative bleeding. The requirement for postoperative analgesics was significantly lower (6.4+/-7.3 vs. 1.5+/-1.2 doses, P<0.05) and hospital stay significantly shorter (8.6+/-2.1 vs. 15.6+/-6.3 d, P<0.01) after laparoscopic cholecystectomy. There were no postoperative complications in either group. Thus, early laparoscopic cholecystectomy seems appropriate for acute gangrenous cholecystitis. Conversion to open cholecystectomy may be required in difficult cases with complications.
authors.affiliation: Department of Surgery, Shutoh General Hospital, 1000-1 Kogaisaku, Yanai, Yamaguchi 742-0032, Japan. ttsushimi@yahoo.co.jp
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tsushimi
authors.forename: Norichika
authors.initials: N
authors.lastname: Matsui
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takemoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurazumi
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Oka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seyama
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Morita
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000473:pathology / Q000601:surgery*; D005260:Female; D005734:Gangrene; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome