Langenbeck's Archives of Surgery

, Volume 390, Issue 5, pp 373–380 | Cite as

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

  • U. Giger
  • J. M. Michel
  • R. Vonlanthen
  • K. Becker
  • T. Kocher
  • L. Krähenbühl
Current Concepts in Clinical Surgery

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.

Keywords

Acute cholecystitis Laparoscopic cholecystectomy Indication Technique Complications 

References

  1. 1.
    Langenbuch C (1882) Ein Fall von Exstirpation der Gallenblase wegen chronischer Cholelithiasis: Heilung. Berlin Klin Wochenschr 19:725–726Google Scholar
  2. 2.
    Mühe C (1986) Cholecystectomie durch das Laparoskop. Langenbecks Arch Klin Chir 369:804Google Scholar
  3. 3.
    Dubois F, Berthelot G, Levard H (1989) Cholecystectomy by coelioscopy. Presse Med 18:980–982PubMedGoogle Scholar
  4. 4.
    Club TSS (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club. N Engl J Med 324:1073–1078PubMedGoogle Scholar
  5. 5.
    Berci G, Sackier JM (1991) The Los Angeles experience with laparoscopic cholecystectomy. Am J Surg 161:382–384CrossRefPubMedGoogle Scholar
  6. 6.
    Baird DR, Wilson JP, Mason EM, Duncan TD, Evans JS, Luke JP, Ruben DM, Lucas GW (1992) An early review of 800 laparoscopic cholecystectomies at a university-affiliated community teaching hospital. Am Surg 58:206–210PubMedGoogle Scholar
  7. 7.
    Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW (1992) Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg 127:917–921 (discussion 921–923)PubMedGoogle Scholar
  8. 8.
    National Institutes of Health Consensus Development Conference Statement on Gallstones and Laparoscopic Cholecystectomy (1993) Am J Surg 165:390–398Google Scholar
  9. 9.
    Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H (1996) Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg 20:43–48 (discussion 48–49)CrossRefPubMedGoogle Scholar
  10. 10.
    Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P (1997) Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 184:571–578PubMedGoogle Scholar
  11. 11.
    Flowers JL, Bailey RW, Scovill WA, Zucker KA (1991) The Baltimore experience with laparoscopic management of acute cholecystitis. Am J Surg 161:388–392CrossRefPubMedGoogle Scholar
  12. 12.
    Phillips EH, Carroll BJ, Bello JM, Fallas MJ, Daykhovsky L (1992) Laparoscopic cholecystectomy in acute cholecystitis. Am Surg 58:273–276PubMedGoogle Scholar
  13. 13.
    Miller RE, Kimmelstiel FM (1993) Laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 7:296–299Google Scholar
  14. 14.
    Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J (1993) Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 218:630–634Google Scholar
  15. 15.
    Unger SW, Nguyen N, Edelman DS, Unger HM (1994) Laparoscopic approach to acute cholecystitis: a four year retrospective review. Int Surg 79:209–212PubMedGoogle Scholar
  16. 16.
    Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J (1998) Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg 133:173–175CrossRefPubMedGoogle Scholar
  17. 17.
    Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D, Campier E, Guiot P, Leroy J, Marescaux J (2001) Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg 25:1352–1356CrossRefPubMedGoogle Scholar
  18. 18.
    Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomized trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325CrossRefPubMedGoogle Scholar
  19. 19.
    Bennett GL, Balthazar EJ (2003) Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am 41:1203–1216PubMedGoogle Scholar
  20. 20.
    Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323PubMedGoogle Scholar
  21. 21.
    Paul A, Millat B, Holthausen U, Sauerland S, Neugebauer E (1998) Diagnosis and treatment of common bile duct stones (CBDS). Results of a consensus development conference. Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.). Surg Endosc 12:856–864CrossRefPubMedGoogle Scholar
  22. 22.
    Abboud PA, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR, Shea JA, Schwartz JS, Williams SV (1996) Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointest Endosc 44:450–455PubMedGoogle Scholar
  23. 23.
    Contractor QQ, Boujemla M, Contractor TM, el-Essawy OM (1997) Abnormal common bile duct sonography. The best predictor of choledocholithiasis before laparoscopic cholecystectomy. J Clin Gastroenterol 25:429–432CrossRefPubMedGoogle Scholar
  24. 24.
    Lomanto D, Pavone P, Laghi A, Panebianco V, Mazzocchi P, Fiocca F, Lezoche E, Passariello R, Speranza V (1997) Magnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases. Am J Surg 174:33–38CrossRefPubMedGoogle Scholar
  25. 25.
    Rijna H, Borgstein PJ, Meuwissen SG, de Brauw LM, Wildenborg NP, Cuesta MA (1995) Selective preoperative endoscopic retrograde cholangiopancreatography in laparoscopic biliary surgery. Br J Surg 82:1130–1133PubMedGoogle Scholar
  26. 26.
    Santucci L, Natalini G, Sarpi L, Fiorucci S, Solinas A, Morelli A (1996) Selective endoscopic retrograde cholangiography and preoperative bile duct stone removal in patients scheduled for laparoscopic cholecystectomy: a prospective study. Am J Gastroenterol 91:1326–1330PubMedGoogle Scholar
  27. 27.
    Cameron IC, Chadwick C, Phillips J, Johnson AG (2002) Acute cholecystitis—room for improvement? Ann R Coll Surg Engl 84:10–13PubMedGoogle Scholar
  28. 28.
    Ransohoff DF, Gracie WA (1993) Treatment of gallstones. Ann Intern Med 119:606–619PubMedGoogle Scholar
  29. 29.
    Somasekar K, Shankar PJ, Foster ME, Lewis MH (2002) Costs of waiting for gall bladder surgery. Postgrad Med J 78:668–669CrossRefPubMedGoogle Scholar
  30. 30.
    Papi C, D’Ambrosio L, Capurso L (2004) Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol 99:147–155PubMedGoogle Scholar
  31. 31.
    Jarvinen HJ, Hastbacka J (1980) Early cholecystectomy for acute cholecystitis. A prospective randomized study. Ann Surg 1991:501–505Google Scholar
  32. 32.
    Schaefer D, Barth H, Thon K, Jostarndt L, Maroske D (1980) Early or delayed operation in patients with acute cholecystitis. Results of a prospective randomized controlled clinical trial. Chir Forum Exp Klin Forsch 1980:149–153Google Scholar
  33. 33.
    Norrby S, Herlin P, Holmin T, Sjodahl R, Tagesson C (1983) Early or delayed cholecystectomy in acute cholecystitis? A clinical trial. Br J Surg 70:163–165PubMedGoogle Scholar
  34. 34.
    Singh NK, Singh RJ, Rai U (1984) Early versus delayed operation for acute cholecystitis. J Indian Med Assoc 82:356–359PubMedGoogle Scholar
  35. 35.
    Misra MC, Khanna S, Khosla A, Berry M, Kapur BM (1988) Emergency versus elective cholecystectomy in acute cholecystitis. Jpn J Surg 4:384–389Google Scholar
  36. 36.
    Ahmad I (1992) Cholecystectomy in acute cholecystitis. J Pak Med Assoc 42:112–115PubMedGoogle Scholar
  37. 37.
    Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227:461–467Google Scholar
  38. 38.
    Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85:764–767CrossRefPubMedGoogle Scholar
  39. 39.
    Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW (2000) Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 66:896–900PubMedGoogle Scholar
  40. 40.
    Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003) Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 7:642–645CrossRefPubMedGoogle Scholar
  41. 41.
    Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1997) Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 21:540–545PubMedGoogle Scholar
  42. 42.
    Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A (1996) Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 10:1045–1049CrossRefPubMedGoogle Scholar
  43. 43.
    Teixeira JP, Saraiva AC, Cabral AC, Barros H, Reis JR, Teixeira A (2000) Conversion factors in laparoscopic cholecystectomy for acute cholecystitis. Hepatogastroenterology 47:626–630PubMedGoogle Scholar
  44. 44.
    Byrne MF, Suhocki P, Mitchell RM, Pappas TN, Stiffler HL, Jowell PS, Branch MS, Baillie J (2003) Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 197:206–211CrossRefPubMedGoogle Scholar
  45. 45.
    Beldi G, Glattli A (2003) Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 17:1437–1439CrossRefPubMedGoogle Scholar
  46. 46.
    Michalowski K, Bornman PC, Krige JE, Gallagher PJ, Terblanche J (1998) Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 85:904–906CrossRefPubMedGoogle Scholar
  47. 47.
    Bornman PC, Terblanche J (1985) Subtotal cholecystectomy: for the difficult gall bladder in portal hypertension and acute cholecystitis. Surgery 98:1–6PubMedGoogle Scholar
  48. 48.
    Stojeba N, Mahoudeau G, Segura P, Meyer C, Steib A (1999) Possible venous argon gas embolism complicating argon gas enhanced coagulation during liver surgery. Acta Anaesthesiol Scand 43:866–867CrossRefPubMedGoogle Scholar
  49. 49.
    Klaiber C, Metzger A (1995) Manual der laparoskopischen Chirurgie. Huber, BernGoogle Scholar
  50. 50.
    Krähenbühl L, Frei E (1996) Five years of laparoscopic cholecystectomy: a reappraisal. In: Büchler MW, Frei E, Klaiber C, Krähenbühl L (eds) Progress in surgery. Karger, Basel, pp 98–102Google Scholar
  51. 51.
    Singer JA, McKeen RV (1994) Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 60:326–328Google Scholar
  52. 52.
    Larson GM, Vitale GC, Casey J, Evans JS, Gilliam G, Heuser L, McGee G, Rao M, Scherm MJ, Voyles CR (1992) Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients. Am J Surg 163:221–226CrossRefPubMedGoogle Scholar
  53. 53.
    Bailey RW, Zucker KA, Flowers JL, Scovill WA, Graham SM, Imbembo AL (1991) Laparoscopic cholecystectomy. Experience with 375 consecutive patients. Ann Surg 214:531–540 (discussion 540–541)PubMedGoogle Scholar
  54. 54.
    Rattner DW, Ferguson C, Warshaw AL (1993) Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 217:233–236Google Scholar
  55. 55.
    Koperna T, Kisser M, Schulz F (1999) Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology 46:753–757PubMedGoogle Scholar
  56. 56.
    Garber SM, Korman J, Cosgrove JM, Cohen JR (1997) Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 11:347–350CrossRefPubMedGoogle Scholar
  57. 57.
    Russell JC, Walsh SJ, Reed-Fourquet L, Mattie A, Lynch J (1998) Symptomatic cholelithiasis: a different disease in men? Connecticut laparoscopic cholecystectomy registry. Ann Surg 227:195–200CrossRefPubMedGoogle Scholar
  58. 58.
    Braghetto I, Csendes A, Debandi A, Korn O, Bastias J (1997) Correlation among ultrasonographic and videoscopic findings of the gallbladder: surgical difficulties and reasons for conversion during laparoscopic surgery. Surg Laparosc Endosc 7:310–315CrossRefPubMedGoogle Scholar
  59. 59.
    Schäfer M, Krähenbühl L, Büchler MW (2001) Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 182:291–297CrossRefPubMedGoogle Scholar
  60. 60.
    Hashizume M, Sugimachi K (1997) Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc 11:1198–1201Google Scholar
  61. 61.
    Schäfer M, Lauper M, Krähenbühl L (2001) Trocar and Veress needle injuries during laparoscopy. Surg Endosc 15:275–280CrossRefPubMedGoogle Scholar
  62. 62.
    Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR (2002) Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg 6:800–805CrossRefPubMedGoogle Scholar
  63. 63.
    Z’graggen K, Wehrli H, Metzger A, Buehler M, Frei E, Klaiber C (1998) Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery. Surg Endosc 12:1303–1310CrossRefPubMedGoogle Scholar
  64. 64.
    Sackier JM, Berci G, Phillips E, Carroll B, Shapiro S, Paz-Partlow M (1991) The role of cholangiography in laparoscopic cholecystectomy. Arch Surg 126:1021–1025PubMedGoogle Scholar
  65. 65.
    Soper NJ, Dunnegan DL (1992) Routine versus selective intra-operative cholangiography during laparoscopic cholecystectomy. World J Surg 16:1133–1140PubMedGoogle Scholar
  66. 66.
    Gigot J, Etienne J, Aerts R, Wibin E, Dallemagne B, Deweer F, Fortunati D, Legrand M, Vereecken L, Doumont J, Van Reepinghen P, Beguin C (1997) The dramatic reality of biliary tract injury during laparoscopic cholecystectomy. An anonymous multicenter Belgian survey of 65 patients. Surg Endosc 11:1171–1178CrossRefPubMedGoogle Scholar
  67. 67.
    Fountain AH, Gotten D, Evans D (1989) The utility of intraoperative cholangiography with acute cholecystitis. Am J Surg 55:392–395Google Scholar
  68. 68.
    Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957CrossRefPubMedGoogle Scholar
  69. 69.
    Rhodes M, Sussman L, Cohen L, Lewis MP (1998) Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161CrossRefPubMedGoogle Scholar
  70. 70.
    Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1997) Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg Laparosc Endosc 7:407–414CrossRefPubMedGoogle Scholar
  71. 71.
    Roslyn JJ, Binns GS, Hughes EF, Saunders-Kirkwood K, Zinner MJ, Cates JA (1993) Open cholecystectomy. A contemporary analysis of 42,474 patients. Ann Surg 218:129–137PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • U. Giger
    • 1
    • 2
  • J. M. Michel
    • 1
    • 3
  • R. Vonlanthen
    • 1
  • K. Becker
    • 1
  • T. Kocher
    • 2
    • 3
  • L. Krähenbühl
    • 1
    • 3
  1. 1.Department of SurgeryHôpital Cantonal FribourgFribourgSwitzerland
  2. 2.Department of SurgeryKantonsspital BadenBadenSwitzerland
  3. 3.Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS)ZurichSwitzerland

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