title: Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium.
abstract: BACKGROUND
  Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking.
  
  
  METHODS
  A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients' clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis.
  
  
  RESULTS
  Fifty-three surgeons consecutively and anonymously included 1,089 patients in this prospective study. A primary open approach was chosen in 74 patients (6.8%), whereas a laparoscopic approach was the first option in 1,015 patients (93.2%). Independent predictive factors for a primary open approach were previous history of upper abdominal surgery [odds ratio (OR) 4.13, p < 0.001], patient age greater than 70 years (OR 2.41, p < 0.05), surgeon with more than 10 years' experience (OR 2.08, p = 0.005), and gangrenous cholecystitis (OR 1.71, p < 0.05). In the laparoscopy group, 116 patients (11.4%) required conversion to laparotomy. Overall, 38 patients (3.5%) presented biliary complications and 49 had other local complications (4.5%). Incidence of bile duct injury was 1.2% in the whole series, 2.7% in the open group, and 1.1% in the laparoscopy group. Sixty patients had general complications (5.5%). The overall mortality rate was 0.8%. All patients who died were in poor general condition [American Society of Anesthesiologists (ASA) III or IV].
  
  
  CONCLUSIONS
  Although laparoscopic cholecystectomy is currently considered as the standard treatment for acute cholecystitis, an open approach is still a valid option in more advanced disease. However, overall mortality and incidence of bile duct injury remain high.
authors.affiliation: Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium. benoit.navez@uclouvain.be
authors.forename: Benoit
authors.initials: B
authors.lastname: Navez
authors.forename: Felicia
authors.initials: F
authors.lastname: Ungureanu
authors.forename: Martens
authors.initials: M
authors.lastname: Michiels
authors.forename: Donald
authors.initials: D
authors.lastname: Claeys
authors.forename: Filip
authors.initials: F
authors.lastname: Muysoms
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.forename: Marc
authors.initials: M
authors.lastname: Vanderveken
authors.forename: Olivier
authors.initials: O
authors.lastname: Detry
authors.forename: Bernard
authors.initials: B
authors.lastname: Detroz
authors.forename: Jean
authors.initials: J
authors.lastname: Closset
authors.forename: Bart
authors.initials: B
authors.lastname: Devos
authors.forename: Marc
authors.initials: M
authors.lastname: Kint
authors.forename: Julie
authors.initials: J
authors.lastname: Navez
authors.forename: Francis
authors.initials: F
authors.lastname: Zech
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gigot
mesh_terms: D000368:Aged; D001530:Belgium; D041881:Cholecystitis, Acute / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors