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PubMed1997

Laparoscopic cholecystectomy for acute cholecystitis: prospective trial.

This prospective study determines the indications for and the optimal timing of laparoscopic cholecystectomy (LC) following the onset of acute cholecystitis. It also evaluates preoperative and operative factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy in the presence of acute cholecystitis. Having been established as the procedure of choice for elective cholelithiasis, LC is now also used for management of acute cholecystitis. Under these circumstances the procedure may be difficult and challenging. Certain favorable and unfavorable conditions may be present that influence the conversion and complication rates. Information about these conditions may be helpful for elucidating the optimal circumstances for LC or when the procedure is best avoided. We performed LC on an emergency basis as soon as the diagnosis was made on all patients presenting with acute cholecystitis from January 1994 to December 1995. All preoperative, operative, and postoperative data were collected on standardized forms. Of the 137 patients registered, 130 were eligible for the audit. Seven patients found by laparoscopic intraoperative cholangiography to have choledocholithiasis were converted for common bile duct exploration and were excluded from the study. Altogether 83 patients (72%) underwent successful LC and 37 (28%) needed conversion to open cholecystectomy. The conversion rate of acute gangrenous cholecystitis (49%) was significantly higher than that for uncomplicated acute cholecystitis (4.5%) (p < 0.00001) and for hydrops (28.5%) and empyema of the gallbladder (28.5%) (p = 0.004). The difference in conversion between the group with acute necrotizing (gangrenous) cholecystitis and the two groups with hydrops and empyema of the gallbladder was not statistically significant (p = 0.07). The complication rates of acute cholecystitis, hydrops, empyema of the gallbladder, and gangrenous cholecystitis were 9.0%, 9.5%, 14.0%, and 20.0%, respectively (p = NS). Patients with an operative delay of 96 hours or less from the onset of acute cholecystitis had a conversion rate of 23%, whereas a delay of more than 96 hours was associated with a conversion rate of 47% (p = 0.022). The complication rate was 8.5% in the laparoscopic group and 27% in the converted group (p = 0.013). Patients over 65 years of age, with a history of biliary disease, a nonpalpable gallbladder, WBC count over 13,000/cc, and acute gangrenous cholecystitis were independently associated with a high LC conversion rate; male patients, finding large bile stones, serum bilirubin over 0.8 mg/dl, and WBC count over 13,000/cc were independently associated with a high complication rate following laparoscopic surgery with or without conversion. Generally, LC can be performed safely for acute cholecystitis, with acceptably low conversion and complication rates. Different forms of cholecystitis carry various conversion and complication rates in selected cases. LC for acute cholecystitis should be performed within 96 hours of the onset of disease. Predictors of conversion and complications may be helpful when planning the laparoscopic approach to acute cholecystitis.

Acute Disease↗
PubMed2002

CT findings in acute gangrenous cholecystitis.

OBJECTIVE: The purpose of this study was to determine the CT findings in acute gangrenous cholecystitis. MATERIALS AND METHODS: Four observers retrospectively reviewed CT scans in 75 patients (23 with acute gangrenous cholecystitis, 25 with acute non-gangrenous cholecystitis, and 27 without cholecystitis). The following findings were evaluated: distention, mural thickening, wall enhancement, irregular wall, wall striation, intraluminal membranes, pericholecystic inflammation, gallstones, pericholecystic fluid, enhancement of liver parenchyma, pericholecystic abscess, and gas in the wall or lumen. Sensitivity and specificity of CT for gangrenous cholecystitis and for each finding were calculated. Two reviewers in consensus measured gallbladder dimension and wall thickness. Logistic regression models were used to predict gangrenous versus non-gangrenous cholecystitis. RESULTS: Sensitivity, specificity, and accuracy of CT for acute cholecystitis were 91.7%, 99.1%, and 94.3%, respectively, and for acute gangrenous cholecystitis were 29.3%, 96.0%, and 64.1%, respectively. Findings with the highest specificity for gangrenous cholecystitis were gas in the wall or lumen (100%), intraluminal membranes (99.5%), irregular or absent wall (97.6%), and abscess (96.6%). The difference between the mean gallbladder wall thickness and the short-axis dimension for the two groups with cholecystitis was statistically significant. In three patients with gangrenous cholecystitis, no mural enhancement was seen. Pericholecystic fluid also achieved statistical significance for the diagnosis of gangrene. Multivariate logistic regression analysis showed that the overall accuracy of CT for gangrenous cholecystitis was 86.7%. CONCLUSION: CT findings most specific for acute gangrenous cholecystitis are gas in the wall or lumen, intraluminal membranes, irregular wall, and pericholecystic abscess. Gangrenous cholecystitis is associated with a lack of mural enhancement, pericholecystic fluid, and a greater degree of gallbladder distention and wall thickening.

Acute Disease↗
PubMed2003

Does this patient have acute cholecystitis?

CONTEXT: Although few patients with acute abdominal pain will prove to have cholecystitis, ruling in or ruling out acute cholecystitis consumes substantial diagnostic resources. OBJECTIVE: To determine if aspects of the history and physical examination or basic laboratory testing clearly identify patients who require diagnostic imaging tests to rule in or rule out the diagnosis of acute cholecystitis. DATA SOURCES: Electronic search of the Science Citation Index, Cochrane Library, and English-language articles from January 1966 through November 2000 indexed in MEDLINE. We also hand-searched Index Medicus for 1950-1965, and scanned references in identified articles and bibliographies of prominent textbooks of physical examination, surgery, and gastroenterology. To identify relevant articles appearing since the comprehensive search, we repeated the MEDLINE search in July 2002. STUDY SELECTION: Included studies evaluated the role of the history, physical examination, and/or laboratory tests in adults with abdominal pain or suspected acute cholecystitis. Studies had to report data from a control group found not to have acute cholecystitis. Acceptable definitions of cholecystitis included surgery, pathologic examination, hepatic iminodiacetic acid scan or right upper quadrant ultrasound, or clinical course consistent with acute cholecystitis and no evidence for an alternate diagnosis. Studies of acalculous cholecystitis were included. Seventeen of 195 identified studies met the inclusion criteria. DATA EXTRACTION: Two authors independently abstracted data from the 17 included studies. Disagreements were resolved by discussion and consensus with a third author. DATA SYNTHESIS: No clinical or laboratory finding had a sufficiently high positive likelihood ratio (LR) or low negative LR to rule in or rule out the diagnosis of acute cholecystitis. Possible exceptions were the Murphy sign (positive LR, 2.8; 95% CI, 0.8-8.6) and right upper quadrant tenderness (negative LR, 0.4; 95% CI, 0.2-1.1), though the 95% CIs for both included 1.0. Available data on diagnostic confirmation rates at laparotomy and test characteristics of relevant radiological investigations suggest that the diagnostic impression of acute cholecystitis has a positive LR of 25 to 30. Unfortunately, the available literature does not identify the specific combinations of clinical and laboratory findings that presumably account for this diagnostic success. CONCLUSIONS: No single clinical finding or laboratory test carries sufficient weight to establish or exclude cholecystitis without further testing (eg, right upper quadrant ultrasound). Combinations of certain symptoms, signs, and laboratory results likely have more useful LRs, and presumably inform the diagnostic impressions of experienced clinicians. Pending further research characterizing the pretest probabilities associated with different clinical presentations, the evaluation of patients with abdominal pain suggestive of cholecystitis will continue to rely heavily on the clinical gestalt and diagnostic imaging.

Abdomen, Acute↗
PubMed1996

MRI of acute cholecystitis: comparison with the normal gallbladder and other entities.

Our purpose was to prospectively compare MRI findings with histopathologic findings in the evaluation of suspected acute cholecystitis. Fourteen patients with clinically suspected acute cholecystitis were entered into the study. MR sequences included T1-weighted fat-suppression and breath-hold spoiled gradient echo (SGE) before and after intravenous gadolinium chelate administration. Percent contrast enhancement (%CE) of the gallbladder wall and gallbladder wall thickness (WT) were measured and liver enhancement patterns determined prospectively on MR images. Correlation was obtained with pathological findings at cholecytectomy in all patients. In a second phase of the study MR images on 10 additional subjects who underwent MR examination for reasons other than hepatobiliary disease were analyzed to determine normal values for %CE and gallbladder wall thickness. Mean %CE was 124.0% in patients with acute cholecystitis (10 patients), 58.0% in patients with chronic cholecystitis (2 patients), and 73.0% in patients with gallbladder malignancy (2 patients). Mean gallbladder WT was 6.1 mm in acute cholecystitis, 4.5 mm in chronic cholecystitis, and 6.0 mm in malignant disease. There was a significant difference in %CE between acute and chronic cholecystitis (p = 0.03); no other significant differences in %CE or WT were observed among the patients with gallbladder disease. Patients without biliary disease had %CE of 37.3% and WT of 2.9 mm, which were both significantly less (p < 0.001) than in patients with acute cholecystitis. Transient enhancement of pericholecystic hepatic parenchyma on immediate postgadolinium SGE images was seen in 7 of 10 patients with acute cholecystitis, and not observed in other patients. Patients with acute cholecystitis had increased %CE and WT on MR images that were significantly greater than normal and %CE that was significantly greater than in patients with chronic cholecystitis. Transient increased pericholecystic hepatic enhancement was observed in 70% of acute cholecystitis patients and in no other patient groups.

Acute Disease↗
PubMedDate not supplied

The diagnostic utility of HASTE MRI in the evaluation of acute cholecystitis. Half-Fourier acquisition single-shot turbo SE.

PURPOSE: The purpose of this study was twofold: (a) to determine the significance of high signal intensity surrounding the gallbladder as seen on T2-weighted HASTE (half-Fourier acquisition single shot turbo SE) MR images in patients with acute cholecystitis and (b) to determine the sensitivity of T2-weighted HASTE MR images in detecting gallbladder and common bile duct (CBD) calculi in patients with acute cholecystitis. METHOD: Seventy-two patients with a suspicion of acute cholecystitis were referred for HASTE MRI over a 2 year period. Forty-one patients underwent MRI after sonography and the remaining 31 patients before sonography. MR images were independently evaluated for the presence of MR pericholecystic high signal and gallbladder and CBD calculi. Findings were correlated with results obtained at sonography and at surgery. RESULTS: Of the 72 patients imaged with HASTE MRI, 55 had cholecystitis based on clinical, sonographic, and/or surgical findings. Of these, 45 had acute and 10 had chronic cholecystitis. HASTE MRI demonstrated MR pericholecystic high signal in 41 of 45 (91%) of the patients with acute cholecystitis. The sensitivity of HASTE MRI in diagnosing acute cholecystitis was 91%. The specificity was 79%. The positive predictive value was 87%, the negative predictive value was 85%, and the overall accuracy of the test was 89%. Gallbladder stones were seen by HASTE MRI in 38 of 41 (93%) of patients with acute calculus cholecystitis demonstrated at sonography. CBD stones were demonstrated by HASTE MRI in seven of nine (78%) patients and by sonography in five of nine (56%) patients with documented choledocholithiasis on conventional cholangiography. CONCLUSION: HASTE MRI has a high degree of accuracy in diagnosing acute cholecystitis based on the single finding of pericholecystic MR high signal. A similar level of accuracy is demonstrated in detecting gallbladder stones. Biliary duct calculi are detected with even greater accuracy than with sonography in patients with acute cholecystitis. Invasive preoperative endoscopic retrograde cholangiography may therefore be limited to only those patients with acute cholecystitis and CBD stones demonstrated on HASTE MRI. These features make HASTE MRI and ideal imaging modality in the initial evaluation of acute biliary pain and may ultimately replace sonography in the preoperative evaluation of acute cholecystitis.

Acute Disease↗
PubMedDate not supplied

Guidelines to laparoscopic management of acute cholecystitis.

OBJECTIVE: The present work aims at identifying preoperative variables that may help the surgeon choosing the most appropriate operative approach in various clinical presentation of acute cholecystitis. SUMMARY BACKGROUND DATA: Conversion rates up to 60% have been reported for laparoscopic management of acute cholecystitis. Previous works indicate that the severity of the gallbladder inflammatory process represents the main cause of laparoscopic conversion. The influence of converting a laparoscopic cholecystectomy for acute cholecystitis to open surgery on the post-operative course remains questionable. Objective preoperative variables correlated to the severity of cholecystitis and predictive of laparoscopic cholecystectomy failure remain to be identified. METHODS: Seven preoperative and five post-operative variables were compared among a continuous series of 62 patients operated for acute cholecystitis either by a successful laparoscopic procedure (37 patients) or by a laparoscopic procedure converted to open surgery (14 patients) or directly by open surgery (11 patients). The post-operative outcome of patients in the 3 groups were compared. Determinant preoperative factors correlated with the need to convert a laparoscopic procedure were searched by the CHI square test for independance and by a multivariate logistic regression analysis. RESULTS: Converting a laparoscopic cholecystectomy for acute cholecystitis to open surgery does not worsen the patients early post-operative course as long as conversion is decided rapidly and before peroperative complications arise. Three preoperative independent variables predictive of the need to convert a laparoscopic cholecystectomy for acute cholecystitis were identified: The thickness of the gallbladder wall, preoperative C reactive protein seric levels and finally the delay between the start of acute symptoms of cholecystitis and surgery. CONCLUSIONS: The post-operative outcome of patients operated for acute cholecystitis depends more on the severity of the disease than on the type of the surgical procedure. Patients with a perforated cholecystitis (grade III) should better be handled immediately by open surgery. Patients with acute edematous cholecystitis (grade I) or with empyema or gangrenous cholecystitis (grade II) coming early to surgery (within 72 hrs) and having seric preoperative CRP levels less than 10 mg/% represent the best candidates to laparoscopic surgery.

Acute Disease↗
PubMed1994

Laparoscopic cholecystectomy for acute or gangrenous cholecystitis.

Over the past 4 years, laparoscopy has become the preferred approach for cholecystectomy in the majority of patients. Most of the early articles described laparoscopic cholecystectomy for chronic cholecystitis or presented only a limited number of patients with an acute process. This paper reviews our experience with laparoscopic cholecystectomy for acute and gangrenous cholecystitis. There were 460 attempted laparoscopic cholecystectomies, including 44 for acute nongangrenous cholecystitis and 24 for gangrenous cholecystitis. The conversion rate to open cholecystectomy was 2.8 per cent for chronic cholecystitis, 13.6 per cent for acute, and 75 per cent for gangrenous cholecystitis. The length of operation for laparoscopic compared with open cholecystectomy for acute cholecystitis was not significantly different. For gangrenous cholecystitis, the laparoscopic approach took significantly longer than the open method. The length of stay for acute cholecystitis was significantly shorter for laparoscopy compared with the open method. There was no significant difference in length of stay for gangrenous cholecystitis. With a conversion rate of 75 per cent, no shorter length of stay, and a significantly longer operation, the use of the laparoscopic approach when gangrenous cholecystitis is suspected should be questioned.

Acute Disease↗
PubMed2005

Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND: Complicated acute cholecystitis, for example when empyema or gangrene is present, is associated with increased postoperative morbidity and mortality rates. The aim of this study was to determine the correlation between sex, the severity of acute cholecystitis and the outcome of laparoscopic cholecystectomy. METHODS: Of 674 patients in whom laparoscopic cholecystectomy was attempted, 348 had chronic cholecystitis and 326 had acute cholecystitis. The medical records of the latter were reviewed retrospectively. RESULTS: The proportion of male patients significantly increased with the severity of cholecystitis: 37.4 per cent of those with chronic cholecystitis were men, compared with 44.4 per cent of those with uncomplicated acute cholecystitis and 57 per cent of those with complicated acute cholecystitis (P = 0.001). Multivariate analysis showed that advanced age (odds ratio 2.24; P = 0.004) and male sex (odds ratio 1.76; P = 0.029) independently predicted complicated acute cholecystitis. The conversion rate to open operation was 6.4 per cent in men and 5.9 per cent in women (P = 0.843). The postoperative complication rate was 10.3 and 8.2 per cent respectively (P = 0.528). CONCLUSION: Male sex was identified as a risk factor for more severe acute cholecystitis, but outcome for men after laparoscopic cholecystectomy was not significantly different from that for women.

Cholecystectomy, Laparoscopic↗
PubMed2005

Gangrenous cholecystitis: prediction with CT imaging.

The aim of this study is to determine the usefulness of different patterns of gallbladder mucosal enhancement on contrast-enhanced computed tomography (CT) for differentiating between gangrenous and uncomplicated acute cholecystitis. This retrospective evaluation involved 56 patients with histopathologically proved acute cholecystitis (32 with gangrenous and 24 with uncomplicated acute cholecystitis) who had preoperative contrast-enhanced CT imaging. CT in 38 patients showed a gallbladder mucosal enhancement pattern that could be categorized into continuous, discontinuous, and/or irregular categories. In the other 18 patients, the mucosal enhancement pattern could not be classified due to lack of mucosal enhancement or inadequate mucosal enhancement. On contrast-enhanced CT evaluation, continuous and discontinuous and/or irregular mucosal enhancement patterns were seen in 20 and 18 patients, respectively. Among the 20 patients with continuous mucosal enhancement, 17 had uncomplicated acute cholecystitis. Seventeen of the 18 patients with discontinuous and/or irregular mucosal enhancement had gangrenous cholecystitis. The sensitivity and positive predictive value (PPV) of discontinuous and/or irregular mucosal enhancement in the diagnosis of gangrenous cholecystitis were 30.3% and 94.4% (17 of 18), respectively. The sensitivity and PPV of continuous mucosal enhancement in the diagnosis of uncomplicated acute cholecystitis were 30.3% and 85.5% (17 of 20), respectively. There was a statistically significant difference (p=0.0005) between the PPV of discontinuous and/or irregular (94.4%) and that of continuous (15%) mucosal enhancement for predicting gangrenous cholecystitis. The pattern of gallbladder mucosal enhancement on CT can be used as a reliable criterion for distinguishing acute, uncomplicated cholecystitis from gangrenous cholecystitis.

Aged↗
PubMed1982

Cholescintigraphy in acute and chronic cholecystitis.

Since the introduction of technetium-99m-labeled cholescintigraphic agents in the mid-1970s, there has been extensive investigation of their role in the evaluation of biliary tract disorders. These agents accurately assess the patency of the cystic and common bile ducts, and to date, their greatest impact has been on the diagnostic evaluation of suspected acute cholecystitis. This article reviews the use of 99mTc-iminodiacetic acid (IDA) derivatives in acute and chronic cholecystitis. Since acute cholecystitis is characterized by cystic duct obstruction, failure of the gallbladder to visualize following 99mTc-IDA administration is indicative of cystic duct obstruction and acute cholecystitis. Using this approach, cholescintigraphy has been shown to be highly sensitive, specific, and efficacious in the diagnosis of acute cholecystitis. Cholescintigraphy is now the procedure of choice for the detection of acute cholecystitis. Unlike its successful applications in acute cholecystitis, cholescintigraphy appears of limited value in chronic cholecystitis. Certain circumstances where cholescintigraphy is of value in chronic cholecystitis are discussed. Whether or not cholescintigraphy may play a greater role in the future in elucidating the pathogenesis of chronic cholecystitis by assessment of biliary kinetics remains unanswered.

Acute Disease↗
PubMedDate not supplied

Mechanisms of impaired gallbladder contractile response in chronic acalculous cholecystitis.

The mechanisms involved in the impaired gallbladder contractile response in chronic acalculous cholecystitis are unknown. To determine the mechanisms that may lead to impaired gallbladder emptying in chronic acalculous cholecystitis, gallbladder specimens removed during hepatic resection (controls) and after cholecystectomy for chronic acalculous cholecystitis were attached to force transducers and placed in tissue baths with oxygenated Krebs solution. Electrical field stimulation (EFS) (1 to 10 Hz, 0.1 msec, 70 V) or the contractile agonists, CCK-8 (10(-9) to 10(-5)) or K(+) (80 mmol/L), were placed separately in the tissue baths and changes in tension were determined. Patients with chronic acalculous cholecystitis had a mean gallbladder ejection fraction of 12% +/- 4%. Pathologic examination of all gallbladders removed for chronic acalculous cholecystitis revealed chronic cholecystitis. Spontaneous contractile activity was present in gallbladder strips in 83% of control specimens but only 29% of gallbladder strips from patients with chronic acalculous cholecystitis (P < 0.05 vs. controls). CCK-8 contractions were decreased by 54% and EFS-stimulated contractions were decreased by 50% in the presence of chronic acalculous cholecystitis (P < 0.05 vs. controls). K(+)-induced contractions were similar between control and chronic acalculous cholecystitis gallbladder strips. The impaired gallbladder emptying in chronic acalculous cholecystitis appears to be due to diminished spontaneous contractile activity and decreased contractile responsiveness to both CCK and EFS.

Adult↗
PubMed1993

Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis.

OBJECTIVE: This article determined which preoperative data correlated with successful completion of a laparoscopic cholecystectomy in patients with acute cholecystitis. SUMMARY BACKGROUND DATA: Although laparoscopic cholecystectomy is the procedure of choice in chronic cholecystitis, its use in acute cholecystitis may be associated with higher costs and complication rates. It is not known which patients with acute cholecystitis are likely to require conversion to open cholecystectomy based on preoperative data or if a cooling-off period with medical therapy can diminish inflammation and increase the chance of successful laparoscopic cholecystectomy. METHODS: All laparoscopic cholecystectomies done by the authors between 10/90 and 2/92 were reviewed. Data on cases of acute cholecystitis were prospectively collected on standardized data forms. RESULTS: Twenty of 281 laparoscopic cholecystectomies were done for acute cholecystitis; 7/20 patients with acute cholecystitis required conversion to open cholecystectomy compared with 6/281 patients undergoing elective operation for chronic cholecystitis. In patients with acute cholecystitis the interval from admission to cholecystectomy in the successful cases was 0.6 days vs. 5 days in the cases requiring conversion to open cholecystectomy (p = .01). Cases requiring conversion to open cholecystectomy also had higher WBC (14.0 vs. 9.0, p < .05), alkaline phosphatase (206 vs. 81, p < .02, and APACHE II scores (10.6 vs. 5.1, p < .05). Ultrasonographic findings such as gallbladder distention, wall thickness, and pericholecystic fluid did not correlate with the success of laparoscopic cholecystectomy. Patients converted from laparoscopic to open cholecystectomy required more operating room time (120 min vs. 87 min, p < .01) and more postop hospital days (6 vs. 2, p < .001). CONCLUSIONS: Laparoscopic cholecystectomy for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery allows inflammation to become more intense, thus increasing the technical difficulty of laparoscopic cholecystectomy.

Acute Disease↗
PubMedDate not supplied

The efficacy of laparoscopy in acute cholecystitis.

OBJECTIVE: To evaluate the role of laparoscopic cholecystectomy in acute cholecystitis and establish the outcomes of this treatment modality at North Oakland Medical Centers. METHODS: This was a retrospective analysis over a three-year period (January 1, 1994 to December 31, 1996), performed at a University-affiliated urban teaching hospital, North Oakland Medical Centers, Pontiac, Michigan. Five hundred and fifty-seven patients underwent surgical treatment for gallbladder disease; 88 patients had acute cholecystitis, and 469 patients had chronic cholecystitis. Acute cholecystitis patients underwent surgery within 72 hours of the onset of symptoms; the patient's selection for laparoscopic cholecystectomy or open cholecystectomy depended on severity of disease, co-morbid factors and surgeon's preference. The parameters of age, gender, operating (OR) time, length of stay, complications, conversion rates from laparoscopic cholecystectomy to open cholecystectomy, and cost were compared in patients who underwent laparoscopic cholecystectomy and/or open cholecystectomy. RESULTS: Patients chosen to undergo laparoscopic cholecystectomy for acute cholecystitis tended to be younger females. Patients treated with laparoscopic cholecystectomy for acute cholecystitis had shorter OR times and LOS compared to patients treated with open cholecystectomy for acute cholecystitis. Conversion rates (CR) were 22% in acute cholecystitis and 5.5% in chronic cholecystitis during the study period; CR diminished considerably between the first and third year. Complications were also lower in patients who underwent laparoscopic cholecystectomy vs. open cholecystectomy. CONCLUSIONS: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for acute cholecystitis; however, the surgical approach should be cautionary because of the spectrum of potential technical hazards. CR is improving as surgeons gain experience.

Acute Disease↗
PubMedDate not supplied

Factors effecting the complications in the natural history of acute cholecystitis.

BACKGROUND/AIMS: Gangrenous cholecystitis, empyema, gallbladder perforation, and biliary peritonitis are severe complications of acute cholecystitis associated with increased morbidity and mortality. This study aimed to evaluate perioperative factors associated with complications of acute cholecystitis. METHODOLOGY: Between January 1993 and October 2000, we performed cholecystectomy in 368 patients with acute cholecystitis. All perioperative data were collected on age, sex, medical history, symptoms, laboratory tests, ultrasound, operative and microbiological findings, morbidity and mortality. RESULTS: There were 305 cases (83%) of acute uncomplicated cholecystitis, 26 (7.1%) of gangrenous cholecystitis, 23 (6.3%) of empyema of the gallbladder, 12 (3.3%) of gallblader perforation, and 2 (0.5%) emphysematous cholecystitis. Risk factors for complicated cholecystitis included male gender, advanced age, associated diseases, temperature above 38 degrees C, and white blood cell count on admission greater than 18,000. Laparoscopic cholecystectomy was attempted on 36 patients (11.8%) with uncomplicated and seven patients (11.1%) with complicated acute cholecystitis. The conversion rate to open cholecystectomy was 19.4% for uncomplicated cases, 28.6% for complicated cases. There were no differences in operative complications between complicated and uncomplicated cases, however, length of hospital stay, postoperative morbidity and mortality were significantly higher in complicated cases. CONCLUSIONS: Sex (male), advanced age, presence of associated disease, high temperature (> 38 degrees C) and leukocytosis are all remarkable risk factors inducing complications in acute cholecystitis. Laparoscopic cholecystectomy can be performed with success in uncomplicated cases.

Acute Disease↗