title: Surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis.
abstract: The aim of this study was to evaluate the surgical outcomes of laparoscopic cholecystectomy (LC) in patients who were diagnosed with severe acute cholecystitis (SAC) and to clarify the useful treatment modalities of SAC. Of 112 patients who presented SAC, we selected 99 patients and divided them into 3 groups: 37 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD; group 1), 62 patients with SAC but not indicated for PTGBD (group 2), and 59 patients with acute and chronic cholecystitis (group 3). The conversion rate was 2.7% (1/37) in group 1, 6.5% (4/62) in group 2, and 1.7% (1/59) in group 3. In groups 1 and 2, the postoperative stay and operative time were longer than those in group 3 with significant difference, respectively (P<0.05). In group 2, there was correlation not only between postoperative stay and age but also between postoperative stay and ASA class (P<0.05). In group 2, there was no correlation between time to operation and operative time and also between time to operation and postoperative stay, however, there was surprisingly significant correlation between time to operation and conversion rate in SAC (P=0.018). In conclusion, PTGBD should selectively be performed in patients with severe comorbidities rather than improving surgical outcomes of LC for severe acute cholecystitis. If patients are not indicated for PTGBD, an early laparoscopic cholecystectomy is recommended because it can decrease conversion rate, although it cannot decrease operative time and postoperative stay.
authors.affiliation: Department of Surgery, School of Medicine, Ajou University, San-5, Wonchondong, Yeongtonggu, Suwon 442-749, South Korea.
authors.forename: Ji Hun
authors.initials: JH
authors.lastname: Kim
authors.forename: Jeong Woon
authors.initials: JW
authors.lastname: Kim
authors.forename: In Ho
authors.initials: IH
authors.lastname: Jeong
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Choi
authors.forename: Byung Moo
authors.initials: BM
authors.lastname: Yoo
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Myung Wook
authors.initials: MW
authors.lastname: Kim
authors.forename: Wook Hwan
authors.initials: WH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D041881:Cholecystitis, Acute / Q000601:surgery* / Q000628:therapy; D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care