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PubMed1993

[Percutaneous gallbladder drainage a good treatment in patients with acute cholecystitis and and poor clinical status].

OBJECTIVE: To evaluate the results of ultrasound-guided percutaneous cholecystostomy in patients with increased surgical risk. SETTING: University Hospital Rotterdam. DESIGN: Retrospective. MATERIAL AND METHOD: 24 patients with acute cholecystitis and an increased surgical risk were treated with ultrasound-guided percutaneous cholecystostomy. Cholecystostomy was successfully performed in all patients. RESULTS: 23 patients showed clinical and biochemical improvement within one week. Minor complications were encountered in three cases (12%) which were treated conservatively. 16 patients suffered from calculous cholecystitis. One patient died after the cholecystostomy from an aspiration pneumonia. Cholecystectomy was performed at a later stage in six patients. One of these patients died six days after surgery from a myocardial infarction. Seven patients had percutaneous or endoscopic therapy for gallstones. In two cases no further therapy for gallstones was performed. Eight patients had acalculous cholecystitis. Four patients, suffering from cholangiocarcinoma and malignant obstruction of the cystic duct, subsequently underwent cholecystectomy (two patients) and percutaneous sclerotherapy of the gallbladder (two patients). Percutaneous cholecystostomy alone sufficed for the four remaining patients with acalculous cholecystitis. CONCLUSION: Percutaneous cholecystostomy for high-risk patients with acute cholecystitis is a low-invasive procedure with low morbidity and mortality. The catheter in the gallbladder offers diagnostic and therapeutic possibilities and does not interfere with cholecystectomy at a later stage. In some cases of acalculous cholecystitis drainage of the gallbladder is the only therapy needed.

Acute Disease↗

PubMed1996

Gallbladder nonvisualization with pericholecystic rim sign: morphine-augmentation optimizes diagnosis of acute cholecystitis.

UNLABELLED: This study investigated the value of morphine-augmentation in patients who demonstrated gallbladder nonvisualization with a pericholecystic rim sign at 1 hr, a cholescintigraphic pattern considered highly predictive of acute cholecystitis. METHODS: Retrospectively, 170 consecutive morphine-augmented cholescintigrams were analyzed for the presence of a pericholecystic rim sign, marked or mild, associated with gallbladder nonvisualization at 1 hr (before morphine); those with a pericholecystic rim sign were further evaluated for persistent gallbladder nonvisualization versus gallbladder visualization after morphine. Scintigraphic interpretations were correlated with surgical pathology or clinical diagnosis. RESULTS: Before morphine, 43/170 (25%) patients demonstrated gallbladder nonvisualization with a pericholecystic rim sign. Since only 31 had acute cholecystitis, a diagnosis based solely on that scintigraphic pattern would have resulted in 12 false-positives. After morphine, gallbladder visualization correctly excluded acute cholecystitis in seven; a single false-negative was encountered; five false-positives remained. Morphine-augmentation improved the positive predictive value from 72% (gallbladder nonvisualization with pericholecystic rim sign before morphine) to 86% (gallbladder nonvisualization after morphine). Of 24 patients with marked pericholecystic rim signs, 21 had acute cholecystitis. Of 31 with acute cholecystitis, however, 10 (32%) had a mild pericholecystic rim sign. CONCLUSION: Morphine-augmented cholescintigraphy optimizes the diagnosis of acute cholecystitis in patients with the suggestive, but not pathognomonic, cholescintigraphic pattern at 1 hr of gallbladder nonvisualization with a pericholecystic rim sign, regardless of its intensity.

Acute Disease↗

PubMedDate not supplied

Surgical risks of acute cholecystitis in elderly.

BACKGROUND/AIMS: For the elderly patient, an emergency biliary procedure carries a higher risk than an elective operation. Recently introduced advances in ultrasonography and critical care medicine have affected the clinical risks of surgery for acute cholecystitis in the elderly. This study evaluated the clinical risks of open cholecystectomy for the elderly with acute cholecystitis. MATERIALS AND METHODS: During a 10 year period (1985-1994), a total of 145 patients were diagnosed with acute cholecystitis and underwent cholecystectomy. According to their age, the patients were divided into 3 groups (Group A < 59 years of age; Group B between 60-69 years of age; Group C > 70 years of age). The characteristics and the surgical risk factors in open cholecystectomy for the elderly with acute cholecystitis were evaluated. RESULTS: The rate of acalculous cholecystitis and choledochal stones were significantly (p < 0.05) high in Group C. Septic complication, gangrenous changes, and positive bile culture were also increased parallel to the increase in age. A noteworthy finding was an incidental carcinoma found in a case in group B and in 3 cases in group C. Hospital stay was significantly longer in Group C than in the other groups due to pre-operative complications and post-operative morbidity. CONCLUSION: With respect to increase in elderly patients with acute cholecystitis who present more frequent gangrenous changes and carcinomatous changes as well as high rate of septic complication, successful treatment of these patients is increased when early surgery can be performed on the basis of accurate and prompt diagnosis using imaging modalities and meticulous peri-operative management.

Acute Disease↗

PubMed1997

Microangiopathy in acute acalculous cholecystitis.

BACKGROUND: Acute acalculous cholecystitis is a well recognized complication of many acute illnesses. Ischaemia of the gallbladder seems to have an important role in its pathogenesis. METHODS: Microangiography was performed in 15 gallbladders immediately after cholecystectomy by infusing 10 per cent barium sulphate into the specimen. Five patients had symptomatic gallstone disease, five had acute gallstone-associated cholecystitis and five had acalculous cholecystitis. Sections for histological examination were taken from adjacent sides of the microangiography section. Filling of the vessels by contrast medium was compared with histological findings. RESULTS: Microangiography of the gallbladder in acute gallstone-associated cholecystitis showed strongly dilated arterioles and regular filling of the capillary network, whereas in acalculous cholecystitis the capillary filling was poor and irregular. CONCLUSION: Disturbed microcirculation may play an important role in the pathogenesis of acute acalculous cholecystitis.

Adult↗

PubMed1998

Ultrasound-guided percutaneous transhepatic drainage of gallbladder followed by cholecystectomy for acute cholecystitis--10 years' experience.

Acute cholecystitis is a common disease which may carry the risk of complications, including empyema, perforation, abscess, peritonitis and sepsis. Percutaneous transhepatic drainage of the gallbladder (PTGBD) with antibiotics can provide prompt decompression of gallbladder in acute cholecystitis and interrupt the natural history of the disease effectively. From July 1986 to June 1996, 154 patients with acute cholecystitis were reviewed retrospectively in Kaohsiung Medical College Hospital. The chief symptoms and signs were pain (98.1%), fever (57.1%) and jaundice (37.7%). WBC count more than 10,000 was noted in 116 (75.3%) patients. Associated diseases included empyema: 42 (27.3%), septic shock: 14 (9.1%), diabetes mellitus: 13 (8.4%), pancreatitis: 10 (6.5%), perforation: 7 (4.5%), liver cirrhosis: 6 (3.9%) and respiratory failure: 1 (0.6%). All of them underwent ultrasound-guided PTGBD immediately after the diagnosis was established. The symptoms and signs disappeared soon after this procedure. Bacterial culture was found positive in 104 (67.5%) of 154 patients in which Escherichia coli (51.9%) was the most common organism, followed by Klebsiella pneumonia (20.2%). After acute stage, 138 patients obtained the cholangiography via PTGBD tube. Gallbladder stones were only noted in 56 (40.6%) patients, gallbladder stone concomitant with common bile duct stone in 26 (18.8%), cystic duct obstruction in 25 (18.1%), acalculous cholecystitis in 21 (15.2%), gallbladder perforation in 1 (0.7%), choledochocyst in 1 (0.7%), and cholecystocolonic fistula in 1 (0.7%). There were 135 patients to undergo surgery after the clinical condition was stable. The operative findings included gallbladder stones only in 88 (65.2%), gallbladder stone concomitant with common bile duct stone in 34 (25.2%), acalculous cholecystitis in 13 (9.6%), choledochocyst in 1 (0.7%), and cholecysto-colonic fistula in 1 (0.7%). The postoperative complications included wound infection 8 (5.9%), UGI bleeding 3 (2.2%), acute renal failure 1 (0.7%) and acute respiratory failure 1 (0.7%). The postoperative mortality rate was 0.7% (1/135), which was much lower than those of previous reports, which not undergoing PTGBD initially. It led us to conclude that PTGBD, as an initial preoperative modality to treat acute cholecystitis, is effective in decreasing postoperative morbidity and mortality.

Acute Disease↗

PubMedDate not supplied

Concurrent primary carcinoma of the gallbladder and acute cholecystitis.

BACKGROUND/AIMS: Primary carcinoma of the gallbladder is rare and associated with a late diagnosis and poor prognosis. Concurrent acute cholecystitis frequently obscures the presence of carcinoma. The information regarding gallbladder carcinoma with acute cholecystitis is limited. In order to better understand the presentation of gallbladder carcinoma with acute cholecystitis, we retrospectively reviewed the data of patients with primary carcinoma of the gallbladder. METHODOLOGY: The data of 86 patients with primary carcinoma of the gallbladder treated between 1979 and 1994 were compiled and reviewed. The patients were divided into 2 groups: Group 1 (with acute cholecystitis, 21 patients) and Group 2 (without cholecystitis, 65 patients). Clinicopathological comparisons were made and evaluated between these two groups RESULTS: The average age of Group 1 patients was older than that of Group 2 patients (75+/-2 years vs. 63+/-2 years; p<0.05). Three Group 1 patients presented with sepsis. The interval between the onset of symptoms and hospital admission in Group 2 patients was significantly (p<0.05) longer than that in Group 1 patients (243+/-95 days vs. 20+/-11 days). Leukocytosis (>11,000/mm3) was more common in Group 1 patients than in Group 2 patients (47.6% vs. 15.4%). Jaundice was more common in Group 2, and fever was common in Group 1. The majority of Group 2 gallbladder cancers were stage V (75.4%). In contrast, 52.4% of Group 1 gallbladder cancers were stage III and 38.1% were stage V. The 30-day postoperative mortality rate in Group 1 and Group 2 patients was 9.5% and 7.7%, respectively. The cumulative survival of Group 1 patients was not different from that of Group 2 patients (log-rank test, p>0.05). CONCLUSIONS: Age, the interval of symptoms prior to admission, the location of abdominal pain, fever, leukocytosis, and the absence of jaundice suggested the presence of acute cholecystitis in gallbladder carcinoma. A high index of suspicion of the disease, intraoperative examination of gallbladder specimens, and more aggressive surgical treatment may improve patient survival.

Acute Disease↗

PubMedDate not supplied

[Acute cholecystitis: analysis of the different therapeutic approaches in a General Surgery Service during the years 1994-1996].

INTRODUCTION: The commonly accepted approach in the treatment of acute cholecystitis is urgent cholecystectomy. Laparoscopy has renewed interest in the option of "cooling" the inflammatory process, in order to subsequently carry out a programmed cholecystectomy through the technique mentioned. We present an analysis of the data collected on hospital stay and medico-surgical complications in both therapeutic options. The aim of this work is to reflect on the results obtained in the treatment of acute cholecystitis and to evaluate the results of the application of laparoscopic cholecystectomy in the emergency area. MATERIAL AND METHODS: 152 patients diagnosed with acute cholecystitis are studied. They are distributed in 3 groups, analysing the simple and accumulated hospital stay, the index of medical and surgical complications and mortality. RESULTS: Of the 152 patients with a diagnosis of acute cholecystitis, 91 (59.8%) were operated on in their first admission, 47 (30.9%) were treated using "cooling" of the process to be operated on in a second admission and 14 (9.3%) by means of percutaneous cholecystostomy. A total of 29 patients were readmitted, 4 for relapse of acute cholecystitis and 25 for programmed operations. Urgent conventional cholecystectomy shows a greater rate of infections. The cholecystectomy on second admission supposes a moderate increase of the accumulated average stay. 17% of these patients were operated on using open surgery. CONCLUSIONS: Urgent surgery seems the most suitable approach in acute cholecystitis. The employment of laparoscopic surgery in these cases probably reduces the rate of the medical and surgical complications due to laparotomy in infectious acute pathology, and increases the comfort of the patient

English Abstract↗

PubMed2003

[Treatment of calculous cholecystitis and its complications].

Results of treatment of 10,724 patients with different forms of acute and chronic cholecystitis are analyzed. Surgical treatment was performed in 7819 (72.9%) patients. Variants of treatment of acute and chronic cholecystitis are presented. Typical cholecystectomy is the basic surgery in patients with acute calculous cholecystitis (63% procedures). Laparoscopic cholecystectomy (LCE) was performed in 37% patients. Two-stage surgeries with previous microcholecystostomy (MCS) and endoscopic papilloshincterotomy (EPST) are indicated in late hospitalization of patients with intoxication and severe concomitant diseases. They permit to prepare patients for cholecystectomy and to decrease scope of surgery. In cholelithiasis and jaundice EPST and MCS are indicated for almost all patients as a preliminary procedure before surgery on the biliary tract and cholecystectomy. This two-stage variant permitted to reduce postoperative lethality from 9.7 to 1.6%. In chronic cholecystitis LCE is the main type of surgery with minimal postoperative lethality. For patients with recurrent calculous cholecystitis, frequent exacerbations, severe concomitant diseases EPST in choledocholithiasis and sanation of gall bladder through fistula are indicated.

Cholecystectomy↗

PubMedDate not supplied

[Acute postoperative acalculous cholecystitis].

After a brief review of acute postoperative acalculous cholecystitis, the Authors report their experience over the past 10 years consisting of 9 out of 520 cases (1.73%) of acute cholecystitis operated on in their department. They describe the surgical procedures after which acute cholecystitis developed, the diagnostic tools used, the laboratory test results and the types of cholecystitis encountered. Morbidity was 50% (4 cases) and mortality 11.1% (1 case). Acute postoperative acalculous cholecystitis obliges the surgeon to make an early diagnosis and intervene equally rapidly with treatment.

Acalculous Cholecystitis↗

PubMed1988

Use of ultrasonographic risk score in the timing of operative intervention for acute cholecystitis.

Timing of operative intervention for acute cholecystitis has long been a subject of debate. However, actual or impending perforation constitutes an absolute indication for prompt operative intervention. To discriminate these cases from those undergoing observation with conservative treatment, clinical and ultrasonographic findings were reviewed and analyzed in 17 patients with acute cholecystitis. Specificity, sensitivity, and accuracy of ultrasonography in discriminating cases of acute cholecystitis, in terms of timing of operative intervention, were calculated retrospectively based on the operative findings. The risk score for each ultrasonographic finding was determined, and the total risk score was calculated for each patient. The calculated total risk score was found to be well correlated with the macroscopic appearance of the gallbladder at operation in cases of acute cholecystitis. Therefore, this score should be useful in determining the timing of operative intervention for acute cholecystitis. However, the usefulness of the variables should further be established prospectively in other patient populations.

Acute Disease↗

PubMed1989

Percutaneous cholecystostomy in the diagnosis and treatment of acute cholecystitis in the high-risk patient.

We performed percutaneous cholecystostomy in 22 critically ill patients with suspected acute cholecystitis. This procedure accurately diagnosed acute cholecystitis in 17 of these 22 patients and excluded the diagnosis in the other 5 patients. Moreover, percutaneous cholecystostomy stabilized the conditions of 16 of the 17 patients with acute cholecystitis, allowing elective surgery in 8 patients and effectively treating 8 patients who never became surgical candidates. Percutaneous cholecystostomy and bile cultures are useful in the diagnosis and treatment of acute cholecystitis and should be performed in critically ill patients with clinical, laboratory, and radiologic evidence of acute cholecystitis and an excessive risk for cholecystectomy.

Acute Disease↗

PubMed2006

Early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND: Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% become symptomatic in a year. Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis. OBJECTIVES: The aim was to compare the early laparoscopic cholecystectomy (less than seven days of onset of symptoms) versus delayed laparoscopic cholecystectomy (more than six weeks after index admission) with regards to benefits and harms. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation IndexExpanded until November 2005. SELECTION CRITERIA: We considered for inclusion all randomised clinical trials comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. DATA COLLECTION AND ANALYSIS: We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis. MAIN RESULTS: We included five trials with 451 patients randomised: 223 to the early group and 228 to the delayed group. Surgery was performed on 222 patients in the early group and on 216 patients in the delayed group. There was no mortality in any of the trials. Four of the five trials were of high methodological quality. There was no statistically significant difference between the two groups for any of the outcomes including bile duct injury (OR 0.63, 95% CI 0.15 to 2.70) and conversion to open cholecystectomy (OR 0.84, 95% CI 0.53 to 1.34). Various other analyses including 'available case analysis', risk difference, statistical methods to overcome the 'zero-event trials' showed no statistically significant difference between the two groups in any of the outcomes measured. A total of 40 patients (17.5%) from the delayed group had to undergo emergency laparoscopic cholecystectomy due to non-resolving or recurrent cholecystitis; 18 (45%) of these had to undergo conversion to open procedure. The total hospital stay was about three days shorter in the early group compared with the delayed group. AUTHORS' CONCLUSIONS: Early laparoscopic cholecystectomy during acute cholecystitis seems safe and shortens the total hospital stay. The majority of the outcomes occurred rarely; hence, the confidence intervals are wide. Therefore, further randomised trials on the issue are needed.

Adult↗

PubMed1985

Ultrasonography, HIDA scintigraphy or both in the diagnosis of acute cholecystitis?

The benefit of early surgery for patients with acute cholecystitis is now accepted but rapid accurate pre-operative diagnosis is important and the single best investigation has not yet been clearly established. All 47 patients with suspected acute cholecystitis admitted to a district general hospital during a 6 month period underwent ultrasonic examination and scintigraphy with HIDA within 48 h of admission. In 23 patients acute cholecystitis was proven. Ultrasound correctly diagnosed this in 21 patients but in 2, changes attributed to chronic cholecystitis only were detected. Two false positive ultrasound results also occurred, one in a patient with adenomyomatosis and acute pancreatitis, the other in a case of duodenitis. HIDA scan was diagnostic in 19 patients but in the remaining 4 the presence of abnormal liver function tests accounted for non-visualization of the biliary tree (a non-diagnostic result). In the absence of jaundice a HIDA scan is the more specific test for confirming acute cholecystitis.

Acute Disease↗

PubMed1993

Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis.

The effectiveness and long-term results of percutaneous cholecystostomy for acute acalculous cholecystitis are evaluated. Fifteen patients with acute acalculous cholecystitis were treated prospectively by this procedure, using a pigtail catheter successfully placed under ultrasonographic and fluoroscopic guidance. Prompt relief of the signs and symptoms of cholecystitis was achieved in 14 patients. One required emergency cholecystectomy for uncontrolled bleeding after drainage. Another patient underwent prophylactic cholecystectomy before further chemotherapy for leukaemia. The remaining 13 patients required no further surgery. Morbidity and mortality rates were 13 per cent and nil respectively. Long-term follow-up showed no recurrence of cholecystitis after removal of the catheter. Percutaneous cholecystostomy is a safe, effective and usually definitive procedure for the treatment of acute acalculous cholecystitis.

Acute Disease↗

PubMed1994

Laparoscopic cholecystectomy for acute cholecystitis.

The safety and efficacy of laparoscopic cholecystectomy for acute cholecystitis were evaluated in a 2-year retrospective review. Results of laparoscopic cholecystectomy in 66 patients with acute inflammation of the gallbladder were compared with those of the standard open procedure for this condition (43 patients) and routine laparoscopic cholecystectomy (227 patients). The laparoscopic procedure for acute cholecystitis was successful in 46 of 66 patients. There was no difference in mean operating time when the inflamed gallbladder was removed laparoscopically or at open surgery (82 versus 84 min); however, each procedure took longer than did routine laparoscopic cholecystectomy (mean 69 min; P < 0.01). There was no difference in analgesic requirement between patients who underwent laparoscopic removal of an acutely inflamed gallbladder and those in the other two groups. Postoperative recovery was significantly faster than that after open surgery (P < 0.01), but took longer than that following routine laparoscopic cholecystectomy (P < 0.01). Inability to identify the cystic duct was the most common reason for conversion to open operation, which occurred in 20 cases of acute cholecystitis. Bile duct injury occurred in one of 66 patients with acute cholecystitis treated laparoscopically, two of 227 cases of routine laparoscopic cholecystectomy but in no patient who underwent open cholecystectomy. In conclusion, laparoscopic cholecystectomy is technically achievable in the majority of patients with acute cholecystitis. The conversion rate is high but, if the procedure is completed successfully, postoperative recovery is more rapid than that after open surgery. However, the method carries a higher incidence of complications and should be attempted only by experienced surgeons.

Acute Disease↗

PubMed1991

[Acute stress-induced cholecystitis].

Acute posttraumatic and postoperative cholecystitis is a serious and life-threatening complication with mortality rates ranging from 10 to 50%. The pathogenesis is multifactorial: possible reasons are blood transfusions, dehydration, narcotics, shock and positive end-expiratory pressure (PEEP). Between 1980 and 1990 12 patients underwent surgery for acute cholecystitis. Six of them suffered from a so-called acute acalculous cholecystitis. Two patients died postoperatively. The symptoms are that of a "common" cholecystitis with leukocytosis, fever, abdominal distension and upper right abdominal pain. Sonography is a good method to establish the diagnosis and helps in the decision for cholecystectomy. Clinicians must remember the possibility of an acute cholecystitis in any surgical patient developing abdominal pain or unexplained fever.

Acute Disease↗

PubMedDate not supplied

Timing of laparoscopic cholecystectomy in acute cholecystitis.

BACKGROUND: Laparoscopic cholecystectomy is associated with an increased conversion rate in acute cholecystitis. AIM: To review the operative management of symptomatic cholelithiasis with particular reference to conversion rates and morbidity for laparoscopic cholecystectomy for acute cholecystitis. METHODS: Patients undergoing cholecystectomy between January 1994 and December 1998 were recruited. Demographic details, diagnosis, duration of symptoms, treatment, outcome, post-operative stay and complications were recorded. RESULTS: Complete data were available on 482 patients (84%). Laparoscopic cholecystectomy was attempted in 120 of 132 patients (91%) with acute cholecystitis and 329 of 350 patients (94%) with non-acute gallbladder disease. Conversion rates were 27% (33/120) and 6.7% (22/329) for acute and non-acute gallbladder disease, respectively (p < 0.001 chi2 test). Relating the interval from onset of symptoms to surgery, conversion rates for acute cholecystitis were: < 3 days, 5/17 (29%); 4 to 42 days, 14/59 (23%) and > 42 days, 14/44 (31%). There were three bile duct injuries, two in the delayed (> 45 days) acute group and one in the non-acute group. CONCLUSION: Early laparoscopic cholecystectomy is the treatment of choice for acute cholecystitis, but is associated with a high conversion rate independent of the timing of surgery.

Cholecystectomy, Laparoscopic↗

PubMed1997

[Laparoscopic cholecystectomy in therapy of acute cholecystitis: immediate versus interval operation].

From January 1991 to May 1996 a total of 3,010 cholecystectomies was performed for cholelithiasis. Pathohistologically an acute cholecystitis was found in 483 patients (16%). The overall proportion of laparoscopic operations has increased from 12.5% in 1991 to 96.6% at present. In patients with acute cholecystitis the proportion of laparoscopic operations has increased from initially only 1.87% up to 83.3%. The duration of surgery (81 min versus 54 min), rate of conversion (12% versus 1.07%) and rate of complications (7.76% versus 2.2%) were all significantly higher in cases of acute cholecystitis than in those without inflammation. There was no mortality in either group. Furthermore no significant difference was found between patients with histopathologically proven acute inflammation and patients with an acute episode of chronic cholecystitis. The duration of complaints, however, had a significant influence on surgical results. In patients that were either operated on within 48 h after the onset of disease or more than 10 days later, the length of the operation was shorter and the rates of conversion and complications were lower. Our results prove that laparoscopic cholecystectomy is also very successful in cases of acute cholecystitis, though a long learning curve has to be expected. Taking efficiency and economy into consideration, surgery within a few days of the onset of disease must be recommended.

Acute Disease↗