Abstract
Objective
The aim of this review was to evaluate surgical outcomes of laparoscopic cholecystectomy for gangrenous and empyematous acute cholecystitis defined as severe acute cholecystitis.
Background
It is not known to what extent surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis differ from those for the nonsevere acute form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases.
Methods
Literature searches were conducted to identify: (1) comparative studies which reported laparoscopic surgical outcomes separately for severe acute and nonsevere acute cholecystitis; (2) studies comparing such an approach with open cholecystectomy, subtotal laparoscopic cholecystectomy or cholecystostomy in severe acute cholecystitis. Results were pooled by standard meta-analytic techniques.
Results
Seven studies with a total of 1,408 patients undergoing laparoscopic cholecystectomy were found. The risks of conversion (RR 3.2, 95% CI 2.5 to 4.2) and overall postoperative complications (RR 1.6, 95% CI 1.2–2.2) were significantly higher in severe acute cholecystitis with respect to the nonsevere acute forms. However, no difference was detected as regards to local postoperative complications. No studies comparing open cholecystectomy or cholecystostomy with urgent laparoscopy were found.
Conclusion
A lower feasibility of laparoscopic cholecystectomy has been found for severe cholecystitis. A lower threshold of conversion is recommended since this may allow to reduce local postoperative complications. Literature data lack valuable comparative studies with other treatment modalities, which therefore need to be investigated.
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References
Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29
Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227:461–467
Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85:764–767
Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW (2000) Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 66:896–900
Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003) Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 7:642–645
Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V (2004) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 18:1323–1327
Papi C, Catarci M, D’Ambrosio L, Gili L, Koch M, Grassi GB, Capurso L (2004) Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol 99:147–155
Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L (2005) Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 92:44–49
Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J (1993) Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 21:630–634
Eldar S, Sabo E, Ash E, Abrahamson J, Matter J (1998) Laparoscopic cholecystectomy for the various types of gallbladder inflammation. Surg Laparosc Endosc 8:200–207
Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S (2000) Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 14:755–760
Schäfer M, Krähenbühl L, Büchler MW (2001) Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 182:291–297
Watanabe Y, Sato M, Abe Y, Iseki S, Sato N, Kimura S (1996) Preceding PTGBD decreases complications of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis. J Laparoendosc Surg 6:161–165
Ransom KJ (1998) Laparoscopic management of acute cholecystitis with subtotal cholecystectomy. Am Surg 64:955–957
Borzellino G, de Manzoni G, Ricci F, Castaldini G, Guglielmi A, Cordiano C (1999) Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg 86:1306–1311
Tsumura H, Ichikawa T, Hiyama E, Kagawa T, Nishihara M, Murakami Y, Sueda T (2004) An evaluation of laparoscopic cholecystectomy after selective percutaneous transhepatic gallbladder drainage for acute cholecystitis. Gastrointest Endosc 59:839–844
Ghahreman A, McCall JL, Windsor JA (1999) Cholecystostomy: a review of recent experience. Aust N Z J Surg 69:837–840
Spira RM, Nissan A, Zamir O, Cohen T, Fields SI, Freund HR (2002) Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg 183:62–66
Borzellino G, Tasselli S, Zerman G, Castaldini G, de Manzoni G (2002) Results of surgical treatment of acute cholecystitis. Prospective study of 280 cases. G Chir 23:79–84
Chikamori F, Kuniyoshi N, Shibuya S, Takase Y (2002) Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis. Surg Endosc 16:1704–1707
Lee KT, Wong SR, Cheng JS, Ker CG, Sheen PC, Liu YE (1998) Ultrasound-guided percutaneous cholecystostomy as an initial treatment for acute cholecystitis in elderly patients. Dig Surg 15:328–332
Indar AA, Beckingham IJ (2002) Acute cholecystitis. BMJ 325:639–643
Miller RE, Kimmelstiel FM (1993) Laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 7:296–299
Wilson RG, Macintyre IM, Nixon SJ, Saunders JH, Varma JS, King PM (1992) Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ 305:394–396
Fabre JM, Fagot H, Domergue J, Guillon F, Balmes M, Zaragosa C, Baumel H (1994) Laparoscopic cholecystectomy in complicated cholelithiasis. Surg Endosc 8:1198–1201
Bonatsos G, Leandros E, Dourakis N, Birbas C, Delibaltadakis G, Golematis B (1995) Laparoscopic cholecystectomy. Intraoperative findings and postoperative complications. Surg Endosc 9:889–893
Al-Abassi AA, Farghaly MM, Ahmed HL, Mobasher LL, Al-Manee MS (2001) Infection after laparoscopic cholecystectomy: effect of infected bile and infected gallbladder wall. Eur J Surg 167:268–273
Koperna T, Kisser M, Schulz F (1999) Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology 46:753–757
Araujo-Teixeira JP, Rocha-Reis J, Costa-Cabral A, Barros H, Saraiva AC, Araujo-Teixeira AM (1999) Laparoscopie ou laparatomie dans la cholécystite aigue (200 cas). Comparaison des résultats et facteurs prédisposants à la conversion. Chirurgie 124:529–535
Jacobs M, Verdeja JC, Goldstein HS (1991) Laparoscopic cholecystectomy in acute cholecystitis. J Laparoendosc Surg 1:175–177
Lee HK, Han HS, Min SK, Lee JH (2005) Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 92:463–466
Teixeira JP, Saraiva AC, Cabral AC, Barros H, Reis JR, Teixeira A (2000) Conversion factors in laparoscopic cholecystectomy for acute cholecystitis. Hepatogastroenterology 47:626–630
Limbosch JM, Druart ML, Puttemans T, Melot C (2000) Guidelines to laparoscopic management of acute cholecystitis. Acta Chir Belg 100:198–204
Bender JS, Duncan MD, Freeswick PD, Harmon JW, Magnuson TH (2002) Increased laparoscopic experience does not lead to improved results with acute cholecystitis. Am J Surg 184:591–594
Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A (1996) Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 10:1045–1049
Bedirli A, Sakrak O, Sozuer EM, Kerek M, Guler I (2001) Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology 48:1275–1278
Del Pin CA, Arthur KS, Honig C, Silverman EM (2002) Laparoscopic cholecystectomy: relationship of pathology and operative time. JSLS 6:149–154
Chang YC (2005) A proposed inflammation grading system for laparoscopic cholecystectomy. Hepatogastroenterology 52:33–36
Mo LR, Yau MP, Tsai CC, Lin RC, Kuo JY, Chan KK, Lin YW, Lin CC, Hwang MH (1995) Ultrasound-guided percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy: a new trial in the treatment of severe acute suppurative cholecystitis. Hepatogastroenterology 42:51–54
Ubiali P, Invernizzi R, Prezzati F (2002) Laparoscopic surgery in very acute cholecystitis. JSLS 6:159–162
Hunt DR, Chu FC (2000) Gangrenous cholecystitis in the laparoscopic era. Aust NZ J Surg 70:428–430
Habib FA, Kolachalam RB, Khilnani R, Preventza O, Mittal VK (2001) Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis. Am J Surg 181:71–75
Bingener J, Stefanidis D, Richards ML, Schwesinger WH, Sirinek KR (2005) Early conversion for gangrenous cholecystitis: impact on outcome. Surg Endosc 19:1139–1141
Sinha R, Sharma N (2002) Acute cholecystitis and laparoscopic cholecystectomy. JSLS 6:65–68
Michalowski K, Bornman PC, Krige JE, Gallagher PJ, Terblanche J (1998) Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 85:904–906
Beldi G, Glattli A (2003) Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 17:1437–1439
Prakash K, Jacob G, Lekha V, Venugopal A, Venugopal B, Ramesh H (2002) Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc 16:180–183
Ito K, Fujita N, Noda Y, Kobayashi G, Kimura K, Sugawara T, Horaguchi J (2004) Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial. AJR 183:193–196
Chopra S, Dodd GD 3rd, Mumbower AL, Chintapalli KN, Schwesinger WH, Sirinek KR, Dorman JP, Rhim H (2001) Treatment of acute cholecystitis in non-critically ill patients at high surgical risk: comparison of clinical outcomes after gallbladder aspiration and after percutaneous cholecystostomy. AJR 176:1025–1031
Tseng LJ, Tsai CC, Mo LR, Lin RC, Kuo JY, Chang KK, Jao YT (2000) Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy. Hepatogastroenterology 47:932–936
Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325
Singer JA, McKeen RV (1994) Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 60:326–328
Lo CM, Fan ST, Liu CL, Lai EC, Wong J (1997) Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg 173:513–517
Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, Joehl RJ (1999) Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 126:680–685
Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D, Cambier E, Guiot P, Leroy J, Marescaux J (2001) Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg 25:1352–1356
Gharaibeh KI, Qasaimeh GR, Al-Heiss H, Ammari F, Bani-Hani K, Al-Jaberi TM, Al-Natour S (2002) Effect of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis. J Laparoendosc Adv Surg Tech A 12:193–198
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A (1996) Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc 10:1045–1049
Arvieux-Barthelemy C, Mestrallet J, Bouchard F, Delannoy P, Radmanesh O, Zattara A, Naud G, Faucheron JL, Eymard P, Dupre A, Leto C (1999) Traitement chirurgical de la cholécystite aigue. Ann Chir 53:472–481
Mallen C, Peat G, Croft P (2006) Quality assessment of observational studies is not commonplace in systematic reviews. J Clin Epidemiol. 59:765–769
Colonval P, Navez B, Cambier E, Richir C, de Pierpont B, Scohy JJ, Guiot P (1997) Is laparoscopic cholecystectomy effective and reliable in acute cholecystitis? Results of a prospective study of 221 pathologically documented cases. Ann Chir 51:689–696
Aguayo Albasini JL, Martinez Gomez DA, Martin Diaz L, Lopez Conesa A, Mansilla Molina D (1992) Results of surgical treatment for gallbladder empyema may be analogous to those of the remaining types of acute cholecystitis. Dig Surg 9:303–307
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Borzellino, G., Sauerland, S., Minicozzi, A.M. et al. Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc 22, 8–15 (2008). https://doi.org/10.1007/s00464-007-9511-6
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DOI: https://doi.org/10.1007/s00464-007-9511-6