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.