Journal of Gastrointestinal Surgery

, Volume 12, Issue 5, pp 829–835 | Cite as

Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

  • Ji Hun Kim
  • Jeong Woon Kim
  • In Ho Jeong
  • Tae Yong Choi
  • Byung Moo Yoo
  • Jin Hong Kim
  • Myung Wook Kim
  • Wook Hwan Kim
original article


The aim of this study was to evaluate the surgical outcomes of laparoscopic cholecystectomy (LC) in patients who were diagnosed with severe acute cholecystitis (SAC) and to clarify the useful treatment modalities of SAC. Of 112 patients who presented SAC, we selected 99 patients and divided them into 3 groups: 37 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD; group 1), 62 patients with SAC but not indicated for PTGBD (group 2), and 59 patients with acute and chronic cholecystitis (group 3). The conversion rate was 2.7% (1/37) in group 1, 6.5% (4/62) in group 2, and 1.7% (1/59) in group 3. In groups 1 and 2, the postoperative stay and operative time were longer than those in group 3 with significant difference, respectively (P < 0.05). In group 2, there was correlation not only between postoperative stay and age but also between postoperative stay and ASA class (P < 0.05). In group 2, there was no correlation between time to operation and operative time and also between time to operation and postoperative stay, however, there was surprisingly significant correlation between time to operation and conversion rate in SAC (P = 0.018). In conclusion, PTGBD should selectively be performed in patients with severe comorbidities rather than improving surgical outcomes of LC for severe acute cholecystitis. If patients are not indicated for PTGBD, an early laparoscopic cholecystectomy is recommended because it can decrease conversion rate, although it cannot decrease operative time and postoperative stay.


Severe acute cholecystitis Laparoscopic cholecystectomy 


  1. 1.
    Patterson EJ, McLoughlin RF, Mathieson JR, Cooperberg PL, MacFarlane JK. An alternative approach to acute cholecystitis. Percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Surg Endosc 1996;10:1185–1188.PubMedCrossRefGoogle Scholar
  2. 2.
    Van Steenbergen W, Ponette E, Marchal G, Pelemans W, Aerts R, Fevery J, De Groote J. Percutaneous transhepatic cholecystostomy for acute complicated cholecystitis in elderly patients. Am J Gastroenterol 1990;85:1363–1369.PubMedGoogle Scholar
  3. 3.
    Watanabe Y, Sato M, Abe Y, Iseki S, Sato N, Kimura S. Preceding PTGBD decreases complications of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis. J Laparoendosc Surg 1996;6:161–165.PubMedGoogle Scholar
  4. 4.
    Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1998;227:461–467.PubMedCrossRefGoogle Scholar
  5. 5.
    Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 2003;7:642–645.PubMedCrossRefGoogle Scholar
  6. 6.
    Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 2004;18:1323–1327.PubMedCrossRefGoogle Scholar
  7. 7.
    Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, Joehl RJ. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 1999;126:680–685. discussion 685–686.PubMedGoogle Scholar
  8. 8.
    Weiss CA 3rd, Lakshman TV, Schwartz RW. Current diagnosis and treatment of cholecystitis. Curr Surg 2002;59:51–54.PubMedCrossRefGoogle Scholar
  9. 9.
    Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for the various types of gallbladder inflammation: a prospective trial. Surg Laparosc Endosc 1998;8:200–207.PubMedCrossRefGoogle Scholar
  10. 10.
    Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S. Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 2000;14:755–760.PubMedCrossRefGoogle Scholar
  11. 11.
    Borzellino G, de Manzoni G, Ricci F, Castaldini G, Guglielmi A, Cordiano C. Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg 1999;86:1521–1525.PubMedCrossRefGoogle Scholar
  12. 12.
    Tsumura H, Ichikawa T, Hiyama E, Kagawa T, Nishihara M, Murakami Y, Sueda T. An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis. Gastrointest Endosc 2004;59:839–844.PubMedCrossRefGoogle Scholar
  13. 13.
    Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis. Surg Endosc 2002;16:1704–1707.PubMedCrossRefGoogle Scholar
  14. 14.
    Indar AA, Beckingham IJ. Acute cholecystitis. BMJ 2002;325:639–643.PubMedCrossRefGoogle Scholar
  15. 15.
    Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 1998;351:321–325.PubMedCrossRefGoogle Scholar
  16. 16.
    Habib FA, Kolachalam RB, Khilnani R, Preventza O, Mittal VK. Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis. Am J Surg 2001;181:71–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Bingener J, Stefanidis D, Richards ML, Schwesinger WH, Sirinek KR. Early conversion for gangrenous cholecystitis: impact on outcome. Surg Endosc 2005;19:1139–1141.PubMedCrossRefGoogle Scholar
  18. 18.
    Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D, Cambier E, Guiot P, Leroy J, Marescaux J. Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg 2001;25:1352–1356.PubMedCrossRefGoogle Scholar
  19. 19.
    Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 1993;218:630–634.PubMedCrossRefGoogle Scholar
  20. 20.
    Tseng LJ, Tsai CC, Mo LR, Lin RC, Kuo JY, Chang KK, Jao YT. Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy. Hepatogastroenterology 2000;47:932–936.PubMedGoogle Scholar
  21. 21.
    Madan AK, Aliabadi-Wahle S, Tesi D, Flint LM, Steinberg SM. How early is early laparoscopic treatment of acute cholecystitis? Am J Surg 2002;183:232–236.PubMedCrossRefGoogle Scholar
  22. 22.
    Tsushimi T, Matsui N, Takemoto Y, Kurazumi H, Oka K, Seyama A, Morita T. Early laparoscopic cholecystectomy for acute gangrenous cholecystitis. Surg Laparosc Endosc Percutan Tech 2007;17:14–18.PubMedCrossRefGoogle Scholar
  23. 23.
    Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Urgent laparoscopic cholecystectomy in the management of acute cholecystitis: timing does not influence conversion rate. Surg Endosc 2006;20:806–808.PubMedCrossRefGoogle Scholar
  24. 24.
    Beldi G, Glattli A. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 2003;17:1437–1439.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Ji Hun Kim
    • 1
  • Jeong Woon Kim
    • 1
  • In Ho Jeong
    • 2
  • Tae Yong Choi
    • 3
  • Byung Moo Yoo
    • 4
  • Jin Hong Kim
    • 4
  • Myung Wook Kim
    • 1
  • Wook Hwan Kim
    • 1
  1. 1.Department of Surgery, School of MedicineAjou UniversitySuwonSouth Korea
  2. 2.Department of Surgery, School of MedicineCheju National UniversityJejuSouth Korea
  3. 3.Department of Surgery, Halla General HospitalJejuSouth Korea
  4. 4.Department of Gastroenterology, School of MedicineAjou UniversitySuwonSouth Korea

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