title: Laparoscopic cholecystectomy: a safe approach for management of acute cholecystitis.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) is increasingly being used as an appropriate early treatment in patients with cholecystitis. This study evaluated the safety, effectiveness, and complications of LC in all cases of acute cholecystitis.
  
  
  METHODS
  A retrospective study involved the patients who underwent LC for acute cholecystitis within 72 hours of admission. The preoperative diagnosis was based on clinical, laboratory, and echographic examinations, while the final diagnosis was confirmed by histopathological examination of the excised gallbladder.
  
  
  RESULTS
  We identified 184 patients with acute cholecystitis. Intraoperative cholangiography (IOC) was not performed. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 62 patients (33.7%), and postoperative ERCP in 13 patients (7.1%). Conversion to open cholecystectomy was necessary in 19 patients (10.3%); 16 patients for severe inflammation and adhesions and 3 patients because of uncontrolled bleeding. The mean operative time was 68 minutes. No deaths occurred. The overall complication rate was 6% with 3 postoperative bile leakages and 2 nonbilious subhepatic collections. The mean postoperative hospital stay was 2.8 days.
  
  
  CONCLUSIONS
  LC is a safe, effective procedure for the early management of patients with acute cholecystitis. LC can be safely performed without routine IOC when ERCP is performed preoperatively on the basis of specific indications. Meticulous dissection and good exposure of Calot's triangle may prevent bile duct injuries.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Royal London Hospital, UK. drsgourgiotis@tiscali.co.uk
authors.forename: Stavros
authors.initials: S
authors.lastname: Gourgiotis
authors.forename: Nikitas
authors.initials: N
authors.lastname: Dimopoulos
authors.forename: Stylianos
authors.initials: S
authors.lastname: Germanos
authors.forename: Vasilis
authors.initials: V
authors.lastname: Vougas
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Alfaras
authors.forename: Evangelos
authors.initials: E
authors.lastname: Hadjiyannakis
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome