Acute calculous cholecystitis in the time of laparoscopic cholecystectomy

Abstract

Introduction. Acute calculous cholecystitis (ACC) is a frequent pathology, defined as an acute inflammatory condition of the gallbladder in the presence of gallstones. It is one of the most common causes of hospitalization in surgical units. It occurs at any age, with maximum incidence at middle ages. Although the laparoscopic cholecystectomy (LC) nowadays has become a gold standard in the treatment of symptomatic gallbladder lithiasis, its role in the treatment of ACC remains unclear. Aim of the study. Assessment of the value of laparoscopic cholecystectomy for resolution of ACC. Materials and methods. A retrospective-prospective study based on 50 patients admitted into the Surgical Department of Municipal Clinical Hospital no.1 during 2018-2019, with diagnosis on admission ACC. The study group composed of 41 women (82%) and 9 men (18%), the W/ M ratio being 8/1. The age of the patients ranged from 24 to 85 years, with average 56.8 ± 2.2 years. Results. Surgical treatment underwent 49 patients. One patient has undergone a primary laparotomy for ACC associated with Mirizzi syndrome diagnosed preoperatively, and 48 patients – LC. In one case, after a diagnostic laparoscopy was taken the decision to refuse from cholecystectomy, due to liver cirrhosis and risk of major bleeding. Forty (80%) patients were operated in the first 72 h after hospitalization, and another 20% of patients – after 72h or more. The latest operation was performed after 14 days of hospitalization, in a patient with severe concomitant cardiovascular diseases. From all of the cases of LC, the conversion was needed in only one patient because of the numerous adhesions with the transverse colon and the paravesical abscess, in a 81 year old patient with Charlson Comorbidity Index 8 points. After all of laparoscopic interventions, the subhepatic space was drained with a tube. The average length of the surgery was 46.2 ± 3.88 min, with The shortest intervention – 15 min., and the longest one – 85 min. The diagnosis of ACC was confirmed in 90% of cases. However, in 10% of cases postoperative pathological examination revealed the diagnosis of chronic cholecystitis. According to AAST severity score, cases of ACC were classified as follow: AAST I - 66%, AAST II - 26%, AAST III - 2% and AAST IV - 6%. All patients had an uneventful postoperative period. Conclusions. LC is the most argued method of treatment in the case of ACC, regardless of the patient's age, presenting well-known advantages such as: shortening of the operative time, more favorable postoperative period, minimizing the post-operative complications and reducing the length of hospital stay. ACC underwent surgical treatment within the first 72 hours from the onset seems to be associated with the faster recovery of patients.