Mini-cholecystectomy: a personal series in acute and chronic cholecystitis.
BACKGROUND
Minimally invasive techniques in the surgical treatment of gallbladder disease include laparoscopic cholecystectomy (LC) and mini-cholecystectomy (MC). Reports of LC in acute or chronic inflammation of the gallbladder are common, but those of MC are much more limited, particularly in complicated cases.


METHODS
Thirty-six consecutive patients with gallstone disease who underwent mini-cholecystectomy (MC) were included in this study. Twenty-four were female, median age 62 years (range 23-82) and median body mass index (BMI) was 23.4 (range 17.0-28.4). Seventeen of 36 patients had an acutely inflamed gallbladder, one with septicaemia, and six had gangrenous cholecystitis. Three patients presented with acute pancreatitis. MC was performed by a standardised technique. Operative time, frequency of postoperative analgesic injections, time to start oral diet after operation and length of postoperative hospital stay were compared between patients with chronic and acute cholecystitis.


RESULTS
The median operative time was 92.5 minutes (range 35-130). There was no difference in operative time between patients with chronic and acute cholecystitis: 80 minutes (range 35-120) vs 95 minutes (range 60-130). The frequency of postoperative analgesic injections was also similar in the two groups. Oral diet could be started within 24 h of operation in all except one patient with chronic cholecystitis but in only 8 of 17 with acute cholecystitis. Postoperative hospital stay was shorter in patients with chronic cholecystitis: 2 days (range 2-5) vs 4 days (range 2-14), p =0.0009.


CONCLUSIONS
MC is an effective surgical procedure for an inflamed gallbladder regardless of the degree and type of inflammation. Patients with chronic cholecystitis recover more quickly and have a shorter hospital stay.
Watanapa
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Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand. sipwt@mahidol.ac.th