BACKGROUND/AIMS: Although laparoscopic cholecystectomy already occupies an important role in acute cholecystitis, a high rate of conversion continues to be referred to in the series published. One of the objectives of this study is to assess the preoperative factors that might lead to conversion. METHODOLOGY: 100 laparoscopic cholecystectomies for acute cholecystitis were studied of which 24 were converted. Several parameters are taken into consideration: age, sex, ASA, echographic data, bacteriological examination of the bile, time elapsing between diagnosis and surgery, morbidity and mortality. RESULTS: The analysis made in relation to the preoperative, predetermining factors with regards to the converted cases provided the following elements in unvaried analysis: Preoperative existence of: "plastron" gallbladder (P < 0.002), temperature above 38 degrees C (P < 0.04), leucocytosis (P < 0.02)), time elapsing between diagnosis and surgery (P < 0.005), presence in the echography of pericholecystic liquid (P < 0.0005) and edema (P < 0.001); Klebsiella in the gallbladder bile (P < 0.005). Age (P = 0.136), sex (P = 0.992), associated diseases (P = 0.961), and gallbladder pathology (P = 0.282) did not present statistical differences that would prevent valid conclusions. In multi-varied analysis it was only possible to consider as independent factors the leucocytosis and the time between diagnosis and surgery. CONCLUSIONS: Laparoscopic cholecystectomy is a safe and efficient technique in the treatment of acute cholecystitis, which should constitute the first choice of treatment for this disease. However, it should be carried out within the first 4 days following surgical diagnosis.
BACKGROUND/AIMS: Although laparoscopic cholecystectomy already occupies an important role in acute cholecystitis, a high rate of conversion continues to be referred to in the series published. One of the objectives of this study is to assess the preoperative factors that might lead to conversion. METHODOLOGY: 100 laparoscopic cholecystectomies for acute cholecystitis were studied of which 24 were converted. Several parameters are taken into consideration: age, sex, ASA, echographic data, bacteriological examination of the bile, time elapsing between diagnosis and surgery, morbidity and mortality. RESULTS: The analysis made in relation to the preoperative, predetermining factors with regards to the converted cases provided the following elements in unvaried analysis: Preoperative existence of: "plastron" gallbladder (P < 0.002), temperature above 38 degrees C (P < 0.04), leucocytosis (P < 0.02)), time elapsing between diagnosis and surgery (P < 0.005), presence in the echography of pericholecystic liquid (P < 0.0005) and edema (P < 0.001); Klebsiella in the gallbladder bile (P < 0.005). Age (P = 0.136), sex (P = 0.992), associated diseases (P = 0.961), and gallbladder pathology (P = 0.282) did not present statistical differences that would prevent valid conclusions. In multi-varied analysis it was only possible to consider as independent factors the leucocytosis and the time between diagnosis and surgery. CONCLUSIONS: Laparoscopic cholecystectomy is a safe and efficient technique in the treatment of acute cholecystitis, which should constitute the first choice of treatment for this disease. However, it should be carried out within the first 4 days following surgical diagnosis.
Authors: Juliane Bingener-Casey; Melanie L Richards; William E Strodel; Wayne H Schwesinger; Kenneth R Sirinek Journal: J Gastrointest Surg Date: 2002 Nov-Dec Impact factor: 3.452
Authors: Masahiko Hirota; Tadahiro Takada; Yoshifumi Kawarada; Yuji Nimura; Fumihiko Miura; Koichi Hirata; Toshihiko Mayumi; Masahiro Yoshida; Steven Strasberg; Henry Pitt; Thomas R Gadacz; Eduardo de Santibanes; Dirk J Gouma; Joseph S Solomkin; Jacques Belghiti; Horst Neuhaus; Markus W Büchler; Sheung-Tat Fan; Chen-Guo Ker; Robert T Padbury; Kui-Hin Liau; Serafin C Hilvano; Giulio Belli; John A Windsor; Christos Dervenis Journal: J Hepatobiliary Pancreat Surg Date: 2007-01-30
Authors: Giuseppe Borzellino; Stefan Sauerland; Anna Maria Minicozzi; Giuseppe Verlato; Carlo Di Pietrantonj; Giovanni de Manzoni; Claudio Cordiano Journal: Surg Endosc Date: 2007-08-18 Impact factor: 4.584