Abstracts
2000 Digestive Disease Week

# 2223 Does a Special Interest in Laparoscopy Improve Outcome in the Treatment of Acute Cholecystitis?
Liane S. Feldman, Lori E. Medeiros, Jeffrey Barkun, Harvey H. Sigman, Jacob Garzon, Gerald M. Fried, Montreal, PQ, Canada

Introduction: We tested the hypothesis that surgeons with advanced laparoscopic training would perform laparoscopic cholecystectomy (LC) for acute cholecystitis with improved outcomes compared to surgeons with only basic laparoscopic experience. Methods: Records of patients undergoing cholecystectomy for acute cholecystitis from January 1 1996 to December 31 1998 were reviewed retrospectively. Patients were included if they had clinical (abdominal tenderness and fever =37.5 C and/or WBC =10) and radiologic findings consistent with acute cholecystitis. Of 140 patients meeting these criteria, 65 were cared for by three surgeons who perform advanced laparoscopic procedures (group 1), while 75 were treated by nine general surgeons who perform only cholecystectomy laparoscopically (group 2). The rates of successful LC, complications and length of stay were compared in the two groups. Statistical analysis was performed with the t test, Mann-Whitney U test and Fisher’s exact test. Multivariable regression was used to control for baseline differences in the two groups. Results: Patients in group 2 were older (61±16 vs 54±16 years, p=0.01), had a higher ASA score (1.9±0.7 vs 1.7±0.8, p=0.05), and were more likely to have preoperative fever (53% vs 32%, p=0.02) and pericholecystic fluid on ultrasound (48% vs 29%, p=0.04). The gender distribution and peak WBC count were similar in the two groups. More patients were approached laparoscopically in group 1 (86% vs 72%, p =0.07), and fewer were converted to laparotomy (20% vs 46%, p<0.01). Thus, 45 (69%) of patients in group 1 compared to 29 (39%) in group 2 had successful LC (p<0.01). The operating time was shorter by 11 minutes in group 1 (95% CI 1 to 21 min, p=0.03). The rates of postoperative complications were similar (26% vs 41%, p=0.09). The median postoperative (2 vs 5 days, p<0.01) and total hospital stay (6 vs 9 days, p<0.01) were shorter in group 1. On regression analysis, significant predictors of successful LC included group 1 ( p<0.01), ASA (p<0.01), and age (p=0.02). Predictors of operative time included group 1 (p=0.01), age (p<0.01), ASA (p=0.04) and thickened gallbladder wall (p=0.04). Predictors of postoperative length of stay included group 1 (p<0.01) and ASA (p<0.01). Conclusions: Patients with acute cholecystitis are more likely to undergo successful LC if cared for by surgeons with advanced laparoscopic training. The associated benefits include shorter operative time and length of stay, without an increase in complication rate.