The aim of the study was to demonstrate the importance of early
laparoscopic cholecystectomy for
acute cholecystitis, without "
conservative" treatment (intravenous fluids and
antibiotics for 48-72 hours) to reduce
inflammation. Early
laparoscopic cholecystectomy reduces bile duct injury and the percentage of conversion to open
cholecystectomy. Thirty-five patients with
acute cholecystitis were submitted to early
laparoscopic cholecystectomy, equally divided according to sex. All patients were submitted to US scans preoperatively and operated on by surgeons skilled in emergency laparoscopic operative techniques.
Laparoscopic cholecystectomy was always performed with 4 trochars and the use of a 30 degrees
laparoscope. Technical modifications during early
laparoscopic cholecystectomy were drainage and
decompression with subsequent de-tension and distention of the gallbladder. These manoeuvres entailed the use of Babcock, Endopatch (Ethicon) atraumatic
forceps. In the presence of acute
gallbladder inflammation we dissect the gall-blader well with a suction-irrigation tube. In patients suspected of having common bile duct stones, biliary duct
injuries and/or anatomical changes due to
inflammation, we perform intraoperative cholangiography. Five patients had conversion to open
cholecystectomy (14.2%), in two cases (5.7%) for concomitant choledochal stones, in two cases (5.7%) for biliary
peritonitis and in the fifth case (2.8%) for severe
empyema of the gallbladder.
Laparoscopic cholecystectomy was performed in 20 patients for
acute cholecystitis (57.1%), in 9 patients for
empyema (25.7%) and in 6 patients for gangrenous
cholecystitis. Four cases presented postoperative complications owing to bile leakage from the liver bed, treated with
antibiotic therapy. One patient presented
jaundice on day 30 after laparoscopy owing to inadequate positioning of the clips on the cystic duct, near the common bile duct; ERCP was performed with application of a
prosthesis, which was removed after two months. Our experience and results support the validity of early
laparoscopic cholecystectomy in the treatment of
acute cholecystitis, because it reduces the postoperative length of
hospital stay and hospital costs. Early treatment is always helpful for inflamed and oedematous tissue which favours dissection, while dense, fibrotic adhesions hinder regular dissection with a greater risk of injury to the biliary duct and and a higher conversion rate to open
cholecystectomy.