Conversion rate and complications in laparoscopic cholecystectomy in acute versus chronic cholecystitis: a prospective cohort study
DOI:
https://doi.org/10.18203/2349-2902.isj20262453Keywords:
Chronic cholecystitis, Laparoscopic cholecystectomy, Conversion rate , Postoperative complications , Critical view of safetyAbstract
Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease. However, acute cholecystitis (AC) is traditionally considered more challenging than chronic cholecystitis (CC) due to edema, adhesions, and distorted anatomy in Calot’s triangle. These factors may increase operative time, conversion rates, and complication risks. With modern safety strategies such as the critical view of safety (CVS), outcomes may be comparable between the two conditions.
Methods: A prospective cohort study was conducted including 70 patients undergoing LC, divided into two groups: 35 patients with AC and 35 with CC. Operative time, intraoperative difficulty, conversion to open surgery, postoperative complications, and hospital stay were compared.
Results: The conversion rate was 5.7% in both groups. Operative time was marginally longer in AC but without statistical significance. Intraoperative bleeding, bile leak, wound infection, and subhepatic collection were slightly more frequent in the acute group; however, no statistically significant difference was observed. No major bile duct injury occurred in either group.
Conclusions: LC in AC is safe and feasible when performed with adherence to standard safety principles. Conversion and complication rates are comparable to CC in experienced hands.
References
Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS. 2001;5:89-94.
Strasberg SM. Acute calculous cholecystitis. N Engl J Med. 2008;358:2804-11.
Strasberg SM, Brunt LM. The critical view of safety. J Am Coll Surg. 2010;211(1):132-8.
Unisa S, Jagannath P, Dhir V, Chiranjeeva K, Lalatendu S, Tarun KR. Prevalence of gallstone disease in North India. HPB (Oxford). 2011;13(2):117-25.
Yokoe M, Takada T, Hwang TL, Masahiro Y, Toshihiko M, Miho S, et al. Tokyo Guidelines for acute cholecystitis. J Hepatobiliary Pancreat Sci. 2007;14(1):1-10.
Tyagi SP, Maheshwari V, Sahoo P, Tyagi N, Ashraf SM. Chronic granulomatous cholecystitis: a clinicopathological study of 17 cases. J Indian Med Assoc. 1991;89(10):284-7.
Elshaer M, Gianpiero G, Katie T, Roberto S, Al-Hamali S, Ebdewi H, et al. Subtotal cholecystectomy for difficult gallbladders. JAMA Surg. 2015;150(2):159-68.
Hussain MI, Khan AF. Outcome of laparoscopic cholecystectomy in acute and chronic cholecystitis. Saudi Med J 2006;27(5):657-60.
Randhawa JS, Pujahari AK. Predictive factors for conversion. Indian J Surg. 2009;71:217-21.
Connor S, Garden OJ. Bile duct injury in laparoscopic era. Br J Surg. 2006;93:158-68.
Gurusamy KS, Davidson BR. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev. 2013;(6):CD005440.
Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, et al. Early vs delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004;18(9):1323-7.
Lo CM, Liu CL, Fan ST, Fan ST, Wong J. Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Ann Surg. 1996;223(1):37-42.
Sabiston Textbook of Surgery. Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery. 20th ed. Elsevier. 2017.
Nassar AH, Ashkar KA, Rashed AA. Laparoscopic cholecystectomy and the risk of conversion. J Laparoendosc Adv Surg Tech. 1997;84(5):630-3.
Tokyo Guidelines. Tokyo Guidelines 2018: management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018.
Strasberg SM. Avoidance of bile duct injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;181(1):101-25.