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Surgical Endoscopy

, Volume 10, Issue 4, pp 426–428 | Cite as

Laparoscopic cholecystostomy with delayed cholecystectomy as an alternative to conversion to open procedure

  • G. G. R. Kuster
  • D. Domagk
Original Articles

Abstract

Background: Acute cholecystitis carries the highest incidence of conversion from planned laparoscopic cholecystectomy to open surgery due to unclear anatomy, excessive bleeding, complications, or other technical reasons.

Methods: Laparoscopic tube cholecystostomy was performed instead of immediate conversion to laparotomy in 9 patients with acute cholecystitis after unsuccessful attempts at laparoscopic dissection. Elective laparoscopic cholecystectomy was done 3 months later.

Results: Following this approach eight patients were treated successfully. After 3 months the acute process had subsided sufficiently to allow a safe laparoscopic cholecystectomy. One additional patient died of acute leukemia 6 weeks after cholecystostomy. Before adopting this technique we subjected 171 patients with acute calculous cholecystitis to laparoscopic cholecystectomy; there was an 11% (19 cases) rate of conversion. Since cholecystostomy has begun to be offered as an alternative to conversion, 121 patients with acute cholecystitis have had laparoscopic cholecystectomy and only 2 cases (1.5%) have been converted to immediate open cholecystectomy.

Conclusions: We recommend the alternative of performing a cholecystostomy with delayed laparoscopic cholecystectomy instead of conversion to open procedure when facing a case of acute cholecystitis not amenable to laparoscopic cholecystectomy.

Key words

Laparoscopic cholecystostomy Laparoscopic cholecystectomy Acute cholecystitis Conversion to laparotomy 

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Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • G. G. R. Kuster
    • 1
  • D. Domagk
    • 1
  1. 1.Division of General SurgeryScripps Clinic and Research FoundationLa JollaUSA

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