The Differences Between Laparoscopic Cholecystectomy And Open Cholecystectomy For Acute Lithic Cholecystitis And The Effect Of Cholecystitic Course On Laparoscopic Cholecystectomy

ObjectiveTo research the possibility and the optimal time of laparoscopic cholecystectomy for acute lithic cholecystitisData and methods358 cases of cholecystectomy for acute lithic cholecyetitis in our hospital from Jan.1999 to Oct.2008 were collected,including 142 LC and 216 OC.The LC group were divided into 3 groups according to the paroxysm time:groupⅠ(≤3days),groupⅡ(＞3days,≤7days), groupⅢ(＞7days).All of the LC and OC cases were performed with the same operation method(omitted).The preoperative preparation and the postoperative therapy are similar.The operation time,amount of bleeding during operation,the volume of abdominal cavity drainage, hospital stay,surgical complication,infection of incision and nosocomial infections of LC and OC were recorded to evaluate the possibility of LC for acute lithic cholecystitis.The operation time,amount of bleeding during operation,hospital stay,Surgical complication,conversion rate, infection of incision and nosocomial infections of 3 group of LC were recorded to evaluate the differences between the 3 groups of LC and to conclude the optimal time to perform LC in acute lithic cholecystitis.ResultsGroup LC(n＝142):the average operation time was 72±18.3 min, the average amount of bleeding during operation was 40±24ml, drainage-tubes were placed in 47.8%cases,the average volume of abdominal cavity drainage was 66_ 18ml,the average hospital stay after operation was 3.84±1.5d,the average total hospital stay was 4.44±1.7d, 5.6%with surgical complication,1.4%with incision infection,4.9%with nosocomial infections.Group OC(n＝216):the average operation time was 70±24.5 min, the average amount of bleeding during operation was 82 4±38ml, drainage-tubes were placed in 75%cases,the average volume of abdominal cavity drainage was 115±38ml,the average postoperative hospital stay was 8.9±2.3d,the average total hospital stay was 12.44±4.5d,4.1%with surgical complication,5.1%with incision infection,5.1% with nosocomial infections.Group LC I(n＝78):the average operation time was 66±13.3 min,the average amount of bleeding during operation was 364-28 ml, drainage-tubes were placed in 28.2%cases,the average volume of abdominal cavity drainage was 46±15ml,the average postoperative hospital stay was 3.6±1.4d,the average total hospital stay was 4.3±1.8d, 2.5%converted to open surgery,3.8%with surgical complication,no incision infection,2.6%with nosocomial infections.Group LCⅡ(n＝48):the average operation time was 82±19.3 rain,the average amount of bleeding during operation was 57±17 ml, drainage-tubes were placed in 66.7%cases,the average volume of abdominal cavity drainage was 83±25ml,the average postoperative hospital stay was 4.1±1.6d,the average total hospital stay is 6.1±2.5d, 10.4%converted to open surgery,8.3%with surgical complications,2.1% with incision infection,6.2%with nosocomial infections.Group LCⅢ(n＝16):the average operation time was 114±26.8 min,the average amount of bleeding during operation was 63±21 ml, drainage-tubes were placed in 87.5%cases,the average volume of abdominal cavity drainage was 260±55ml,the average postoperative hospital stay was 6.6±2.1 d,the average total hospital stay is 7.2±3.4 d, 31.2%converted to open surgery,12.5%with surgical complications, 6.2%with incision infection,12.5%with nosocomial infections.ConclusionCompared with OC for acute lithic cholecystitis,LC has several advantages,such as less bleeding during operation,less use of abdominalcavity drainage,shorter hospital stay and lower incision infection rate(P＜0.05),Considering operation time and surgical complication,there is no difference between LC and OC.LC is a safe, effective operation even in acute lethic cholecystitis.The paroxysm time of acute lithic cholicystitis does not affect operation and prognosis,but the difficulty of operation is increased.The operation should be performed as soon as the clinical diagnosis of acute lithic cholicystitis is confirmed.The operation is better done within 7 days of paroxysm and the best is within 3 days.The chance of conversion increases if LC is performed over 7 days of paroxysm.