Cholécystectomie laparoscopique dans les cholécystites aiguës

Abstract

Purpose To determine the feasibility, operative risk and patients'benefit of laparoscopy in emergency cholecystectomy for acute calculous cholecystitis. Patients and methods From January 1991 to December 1998, 234 patients with acute calculous cholecystitis were operated on by emergency laparoscopic cholecystectomy. There were 131 women and 103 men (mean age: 57 years), (Asa 2: 48%, Asa 3: 10%). In seven patients, choledocolithiasis was detected by endoscopic ultrasonography and preoperatively treated by endoscopic sphincterotomy. The mean delay between in-hospital admission and cholecystectomy was 20 hours (2–160). Cholecystectomy was performed with primary approach of Calot's triangle. Intraoperative cholangiography, selectively performed ( n = 70), detected choledocolithiasis in three patients. Results The mean duration of surgery was 149 minutes (62–313). The conversion rate was 13 % and decreased through the years. The postoperative complication rate was 18%. Eight patients (3.4%) had an abdominal complication. One patient (0.4%) died of bile peritonitis after intraoperative undetected main bile duct injury. The mean postoperative hospital stay was 6.04 days. It was 3.5 days only, very old patients and those with severe associated disease being excluded. Conclusion Laparoscopy appears to be a good approach for emergency cholecystectomy in patients with acute calculous cholecystitis.