Acute cholecystitis: indication for emergency laparoscopic cholecystectomy?

Between 1989 and 1992, 43 patients underwent laparoscopic cholecystectomy for acute cholecystitis. Conversion to open cholecystectomy was necessary in one case (2.3%). Morbidity was 14%, i.e. 7% local complications and 7% systemic complications. No lesions of the CBD occurred and no reoperations or reinterventions were required. Mortality was 0%. The main determining factor for the technical difficulty of laparoscopic cholecystectomy was the lapse of time between onset of symptoms and operation. We show the duration of laparoscopic cholecystectomy during the first 6 days of acute cholecystitis (mean 104 min) is statistically different in the following groups of patients (7-14 days p = 0.0049; 15-21 days p = 0.0037; Mann-Whitney-U-test). We therefore conclude that laparoscopic cholecystectomy is a safe method in acute cholecystitis and that the ideal time of operation is as soon as possible within the first 6 days after onset of illness. Performance of laparoscopic cholecystectomy should not be delayed during this period of acute cholecystitis. If the procedure is carried out by well trained laparoscopic surgeons the risks and complications are equal to those of open cholecystectomy.