92064
document
Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis . BACKGROUND Laparoscopic cholecystectomy ( LC ) has become the treatment of choice for elective cholecystectomy , but controversy persists over use of this approach in the treatment of acute cholecystitis . We undertook a randomised comparison of the safety and outcome of LC and open cholecystectomy ( OC ) in patients with acute cholecystitis . METHODS 63 of 68 consecutive patients who met criteria for acute cholecystitis were randomly assigned OC ( 31 patients ) or LC ( 32 patients ) . The primary endpoints were hospital mortality and morbidity , length of hospital stay , and length of sick leave from work . Analysis was by intention to treat . Suspected bile-duct stones were investigated by preoperative endoscopic retrograde cholangiography ( LC group ) or intraoperative cholangiography ( OC group ) . FINDINGS The two randomised groups were similar in demographic , physical , and clinical characteristics . 48 % of the patients in the OC group and 59 % in the LC group were older than 60 years . 13 patients in each group had gangrene or empyema , and one in each group had perforation of the gallbladder causing diffuse peritonitis . Five ( 16 % ) patients in the LC group required conversion to OC , in most because severe inflammation distorted the anatomy of Calot 's triangle . There were no deaths or bile-duct lesions in either group , but the postoperative complication rate was significantly ( p=0.0048 ) higher in the OC than in the LC group : seven ( 23 % ) patients had major and six ( 19 % ) minor complications after OC , whereas only one ( 3 % ) minor complication occurred after LC . The postoperative hospital stay was significantly shorter in the LC than the OC group ( median 4 [ IQR 2-5 ] vs 6 [ 5-8 ] days ; p=0.0063 ) . Mean length of sick leave was shorter in the LC group ( 13.9 vs 30.1 days ; 95 % CI for difference 10.9-21.7 ) . INTERPRETATION Even though LC for acute and gangrenous cholecystitis is technically demanding , in experienced hands it is safe and effective . It does not increase the mortality rate , and the morbidity rate seems to be even lower than that in OC . However , a moderately high conversion rate must be accepted .
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Intervention_Surgical
laparoscopic
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Intervention_Surgical
open cholecystectomy
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Intervention_Surgical
Laparoscopic cholecystectomy
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Intervention_Physical
( LC )
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Intervention_Surgical
elective cholecystectomy
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Intervention_Surgical
LC
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Intervention_Surgical
open cholecystectomy ( OC )
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Intervention_Surgical
OC
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Intervention_Surgical
LC
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Intervention_Surgical
LC
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Intervention_Surgical
intraoperative cholangiography
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Intervention_Surgical
OC
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Intervention_Surgical
LC
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Intervention_Surgical
LC
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Intervention_Surgical
OC
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Intervention_Surgical
OC
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Intervention_Surgical
LC
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Intervention_Surgical
OC
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Intervention_Surgical
LC
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Intervention_Surgical
OC
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Outcome_Mortality
hospital mortality
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Outcome_Mortality
morbidity
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Outcome_Other
length of hospital stay
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Outcome_Other
length of sick leave from work
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Outcome_Physical
Suspected bile-duct stones
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Outcome_Physical
gangrene
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Outcome_Physical
empyema
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Outcome_Physical
perforation of the gallbladder causing diffuse peritonitis
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Outcome_Physical
severe inflammation
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Outcome_Mortality
deaths
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Outcome_Physical
bile-duct lesions
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Outcome_Adverse-effects
postoperative complication
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Outcome_Physical
minor complications
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Outcome_Other
postoperative hospital stay
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Outcome_Other
Mean length of sick leave
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Outcome_Other
safe
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Outcome_Other
effective
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Outcome_Mortality
mortality rate
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Outcome_Mortality
morbidity rate
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Participant_Condition
acute and gangrenous cholecystitis
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Participant_Condition
acute cholecystitis
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Participant_Condition
acute cholecystitis
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Participant_Sample-size
63
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Participant_Sample-size
68
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Participant_Condition
acute cholecystitis
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Participant_Sample-size
31
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Participant_Sample-size
32