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Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

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Abstract

Background

Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking.

Methods

A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients’ clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis.

Results

Fifty-three surgeons consecutively and anonymously included 1,089 patients in this prospective study. A primary open approach was chosen in 74 patients (6.8%), whereas a laparoscopic approach was the first option in 1,015 patients (93.2%). Independent predictive factors for a primary open approach were previous history of upper abdominal surgery [odds ratio (OR) 4.13, p < 0.001], patient age greater than 70 years (OR 2.41, p < 0.05), surgeon with more than 10 years’ experience (OR 2.08, p = 0.005), and gangrenous cholecystitis (OR 1.71, p < 0.05). In the laparoscopy group, 116 patients (11.4%) required conversion to laparotomy. Overall, 38 patients (3.5%) presented biliary complications and 49 had other local complications (4.5%). Incidence of bile duct injury was 1.2% in the whole series, 2.7% in the open group, and 1.1% in the laparoscopy group. Sixty patients had general complications (5.5%). The overall mortality rate was 0.8%. All patients who died were in poor general condition [American Society of Anesthesiologists (ASA) III or IV].

Conclusions

Although laparoscopic cholecystectomy is currently considered as the standard treatment for acute cholecystitis, an open approach is still a valid option in more advanced disease. However, overall mortality and incidence of bile duct injury remain high.

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Acknowledgments

The following members of BGES are gratefully acknowledged for their substantial contributions to the present study: Drs. Jacques Baillieux (Hornu), Jean Beaurang (Willebroek), Michel Bourdon (Libramont), Emmanuel Cambier (Gilly), Bernard Dallemagne (Liège), Georges Decker (Luxembourg), Robert De Keulenner (Auvelais), Didier Deltour (Gosselies), Olivier Dockx (Marche), Raphael Droissart (Brussels), Mary-Lou Druart (deceased) (Brussels), Pierre Guiot (Gilly), Dominique Herman (Libramont), Jean-Luc Jourdan (Liège), Fadi Maassarani (Auvelais), Bernard Majerus (Ottignies), Baudouin Mansvelt (Jolimont), Pierre Mendes Da Costa (Brussels), Benoit Monami (Liège), Karel Mulier (Leuven), Christian Ngongang (Marche), Jacques Peeters (Waremme), Pascal Remy (Hornu), Casper Sommeling (Waregem), Pierre Taziaux (Malmedy), Musa Tugilimana (Ath), and Etienne Veys (Gosselies). The authors also wish to thank Prof C. de Burbure for revising the manuscript.

Disclosures

Authors Benoit Navez, Felicia Ungureanu, Martens Michiels, Julie Navez, Donald Claeys, Filip Muysoms, Catherine Hubert, Marc Vanderveken, Olivier Detry, Bernard Detroz, Jean Closset, Bart Devos, Marc Kint, Francis Zech, and Jean-François Gigot have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium

    Benoit Navez, Catherine Hubert, Julie Navez, Francis Zech & Jean-François Gigot

  2. Hôpital Saint-Joseph, Gilly, Belgium

    Felicia Ungureanu & Martens Michiels

  3. AZ Middelaeres, Gent, Belgium

    Donald Claeys & Filip Muysoms

  4. AZ Middelheim, Antwerpen, Belgium

    Marc Vanderveken

  5. CHU du Sart Tilman, Liège, Belgium

    Olivier Detry & Bernard Detroz

  6. Hôpital Erasme, Brussels, Belgium

    Jean Closset

  7. AZ Onze Lieve Vrouw Ter Linden, Knokke, Belgium

    Bart Devos

  8. AZ St Lucas, Ghent, Belgium

    Marc Kint

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  1. Benoit Navez
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  2. Felicia Ungureanu
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  3. Martens Michiels
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  13. Julie Navez
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  14. Francis Zech
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  15. Jean-François Gigot
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Consortia

The Belgian Group for Endoscopic Surgery (BGES) and the Hepatobiliary and Pancreatic Section (HBPS) of the Royal Belgian Society of Surgery

Corresponding author

Correspondence to Benoit Navez.

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Navez, B., Ungureanu, F., Michiels, M. et al. Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium. Surg Endosc 26, 2436–2445 (2012). https://doi.org/10.1007/s00464-012-2206-7

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  • DOI: https://doi.org/10.1007/s00464-012-2206-7

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