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Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome

  • Current Concepts in Clinical Surgery
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Abstract

Background

Laparoscopic cholecystectomy (LC) has become the treatment of choice for symptomatic cholelithiasis. However, the laparoscopic approach has remained controversial for patients with acute cholecystitis (AC) because of technical difficulties that, compared with open cholecystectomy (OC), might lead to higher complication rates, particularly common bile duct (CBD) injuries and infection.

Methods

We reviewed recent clinical findings on feasibility, safety and potential benefits of LC in patients with AC. An electronic search using the PubMed and MEDLINE databases was performed using the terms laparoscopic cholecystectomy, open cholecystectomy and acute cholecystitis. Pertinent references from articles and books not identified by the search engines were also retrieved. Relevant surgical textbooks were also reviewed.

Conclusions

The early laparoscopic approach has been shown to be technically feasible and at least equally as safe as the open approach. However, extensive inflammation, adhesions and consequent increased oozing can make laparoscopic dissection of Calot’s triangle and recognition of the biliary anatomy hazardous and difficult. Therefore, conversion to OC remains an important treatment option to secure patient safety in such difficult conditions. The question of whether intraoperative cholangiography (IOC) should be used routinely or only selectively has never been resolved. Proponents for each side have put forward compelling arguments.

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Authors and Affiliations

  1. Department of Surgery, Hôpital Cantonal Fribourg, 1700, Fribourg, Switzerland

    U. Giger, J. M. Michel, R. Vonlanthen, K. Becker & L. Krähenbühl

  2. Department of Surgery, Kantonsspital Baden, Baden, Switzerland

    U. Giger & T. Kocher

  3. Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS), Zurich, Switzerland

    J. M. Michel, T. Kocher & L. Krähenbühl

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  1. U. Giger
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  2. J. M. Michel
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  3. R. Vonlanthen
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  6. L. Krähenbühl
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Correspondence to L. Krähenbühl.

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Giger, U., Michel, J.M., Vonlanthen, R. et al. Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome. Langenbecks Arch Surg 390, 373–380 (2005). https://doi.org/10.1007/s00423-004-0509-4

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