Abstracts
1997 Digestive Disease Week

Laparoscopic versus open cholecystectomy for acute cholecystitis. A prospective randomized study.

T Kiviluoto, J Siren, P Luukkonen, E Kivilaakso. Second Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.

In elective surgery, laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) almost completely, but its role in acute cholecystitis (AC), where the operative risks are higher, remains debatable. This study compares the safety and efficacy of these two methods in the treatment of AC.

Methods: Sixty consecutive patients with AC (M/F 31/29, mean age 60.4±2.9 (range 28-88) yrs, duration of symptoms 4.8±1.1 days, MBI 27.6±0.9 kg/m²) were randomized to open (OC, 31pts) or laparoscopic (LC, 29pts) cholecystectomy groups between 1/1995-8/1996. The diagnosis of AC was made on the basis of clinical findings, fever > 37.5°C, leukocytosis (mean 11.3±0.7x10⁹/L), elevated C-reactive protein (mean 136.2±0.6 mg/L), and US evidence of gall stones, thickened gallbladder wall and pericholecystic edema. In LC group, preoperative ERCP was performed when CBD stones were suspected (10 pts), followed by EPT and stone extraction when indicated (3 pts), while in OC group peroperative cholangiography (23 pts) and choledocholithotomy (1 pt) was used.

Results: There was no mortality. In comparison of LC group to OC group, mean operative time was 108.2±10.0 vs. 99.8±7.2 min (N.S.), hospital stay 4.2±0.5 vs. 8±1.3 days (p<0.05) and sick leave 13.9±2.3 vs. 30.1±1.6 days (p<0.05), respectively. In LC group 5 pts were converted to OC, but no bile duct injuries or other major omplications occurred. In the OC group, 8 patient (25.8%, p<0.005) had major complications: gall stone eroded gastric perforation with reoperation and subsequent myocardial infarction (1 pt), pneumonia and sepsis (1 pt), femoral artery embolism (1 pt), wound infection (2 pts), late intestinal occlusion (1 pt), incisional hernia (1 pt), and recidual CBD stone (1 pt).

Conclusion: Laparoscopic cholecystectomy for acute cholecystitis has significantly less operative complications and provides shorter hospital stay and sick leave than open cholecystectomy, and is therefore in experienced hands a safe and recommendable operation for the treatment of this disease.