Laparoscopic versus Open Cholecystectomy in Acute Cholecystitis

From the available data it can be stated that, in acute cholecystitis, emergency or early surgery within 72 h after onset diminishes morbidity and mortality rates, as well as overall hospital stay and costs. All patients with suspected common bile duct stones (10-30% of older patients) should undergo endoscopic retrograde cholangiopancreatography with papillotomy and stone extraction prior to surgery (for which there is a proven benefit with diminished morbidity and mortality rates). Laparoscopic cholecystectomy for acute cholecystitis is safe and feasible and seems to be the new standard treatment in skilled surgical hands because there is no increase in mortality or common bile duct injury rate and only a slightly increased morbidity due to systemic cardiopulmonary and local wound infection problems. Surgeons should ignore the pressure not to convert to open surgery in difficult cases, which include an unclear anatomy in Calot’s triangle, a gangrenous, friable gallbladder which is difficult to handle, uncontrolled bleeding, technical problems and a prolonged operating time with no progress. Spilled gallstones should always be removed to prevent the postoperative formation of abdominal abscesses. Even if the operating time is increased up to 2 h, patients still benefit from the laparoscopic approach, and it is estimated that between 60 and 90% of all patients admitted with acute cholecystitis can be operated on laparoscopically.