Objctive: To assess the current treatment of AC in a single institution in the series, which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as...Objctive: To assess the current treatment of AC in a single institution in the series, which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as the optimal timing for surgery.Methods: From December 1996 to December 2001, 138 (102 women and 36 men) patients underwent laparoscopic cholecystectomy for acute cholecystitis confirmed by histopathological examination. The patients ranged in age from 21 to 85 years of age ( mean age: 45 3 years). Patients were divided into 2 groups (similar in age and ASA classification): group 1 (98 patients) underwent LC within 3 days after the onset of symptoms of acute cholecystitis and group 2 (40 patients) underwent LC after 3 days. Results: Approximately one half of the cases were uncomplicated, 26% were empyema, 13% had gangrenous changes and 7% had hydrops of the gallbladder. Conversion to open cholecystectomy was required in 21 (15 2%) cases. The principal reason for conversion was anatomic uncertainty (14 cases), uncontrolled bleeding (7 cases). The conversion rates in patients who underwent surgery before and after the onset of symptoms were respectively 6∶15. There was no significant difference in operative time (122 0 min in 1 group versus 124 0 min in 2 group) and postoperative stay ( 5 1 days in group 1 vs 6 8 days in group 2). The hepatorenal space was drained in 78 (56 5 %), and the drain is removed in 3rd postoperative days. Twenty six patients (18 8%) had undergone previous abdominal surgery. Thirty seven patients (26 8%) had spillage of bile and/or stones during the procedure. There were no deaths and major complications. Conclusions: LC 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 LC. Intraoperative spillage of bile and stones does not lead to an increase in early complications. LC is safe and effective for acute cholecystitis even when complicated previous surgery, inflammatory adhesions and gangrene. LC has significantly fewer operative complications and provides shorter hospital stay which are medical and economic benefits. LC is safe and effective for acute cholecystitis.展开更多
文摘Objctive: To assess the current treatment of AC in a single institution in the series, which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as the optimal timing for surgery.Methods: From December 1996 to December 2001, 138 (102 women and 36 men) patients underwent laparoscopic cholecystectomy for acute cholecystitis confirmed by histopathological examination. The patients ranged in age from 21 to 85 years of age ( mean age: 45 3 years). Patients were divided into 2 groups (similar in age and ASA classification): group 1 (98 patients) underwent LC within 3 days after the onset of symptoms of acute cholecystitis and group 2 (40 patients) underwent LC after 3 days. Results: Approximately one half of the cases were uncomplicated, 26% were empyema, 13% had gangrenous changes and 7% had hydrops of the gallbladder. Conversion to open cholecystectomy was required in 21 (15 2%) cases. The principal reason for conversion was anatomic uncertainty (14 cases), uncontrolled bleeding (7 cases). The conversion rates in patients who underwent surgery before and after the onset of symptoms were respectively 6∶15. There was no significant difference in operative time (122 0 min in 1 group versus 124 0 min in 2 group) and postoperative stay ( 5 1 days in group 1 vs 6 8 days in group 2). The hepatorenal space was drained in 78 (56 5 %), and the drain is removed in 3rd postoperative days. Twenty six patients (18 8%) had undergone previous abdominal surgery. Thirty seven patients (26 8%) had spillage of bile and/or stones during the procedure. There were no deaths and major complications. Conclusions: LC 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 LC. Intraoperative spillage of bile and stones does not lead to an increase in early complications. LC is safe and effective for acute cholecystitis even when complicated previous surgery, inflammatory adhesions and gangrene. LC has significantly fewer operative complications and provides shorter hospital stay which are medical and economic benefits. LC is safe and effective for acute cholecystitis.
