Laparoscopic cholecystectomy as standard therapy in acute cholecystitis. A prospective study

Between November 1989 and May 1994 103 laparoscopic cholecystectomies were performed for acute cholecystitis. Conversion rate was 4.9%. Mortality was 0. Postoperative morbidity was 10.7% (6.8% local complications, 3.9% systemic complications). None of the complications lead to a reoperation, no injuries of the common bile duct occurred. These results compare favorably to randomized studies of open cholecystectomy and to published result of laparoscopic cholecystectomy for acute cholecystitis. Main determining factor for technical difficulty of the operation was the lapse of time between onset of symptoms and operation. This is expressed in statistically different mean operative times in patients with short (1-6 days) and long (7-14; 15-21 days) clinical history of acute cholecystitis. We therefore conclude that early surgery, in selected cases even emergency surgery is indicated and that in expert hands laparoscopic cholecystectomy can be the treatment of choice for acute cholecystitis.