Acute cholecystitis: Open or laparoscopic surgery?

Abstract

Laparoscopic cholecystectomy is the procedure of choice for uncomplicated symptomatic cholelithiasis. The safety of laparoscopic cholecystectomy in acute cholecystitis is not fully known. Difficulties that may be encountered in acutely inflamed cases and recommended technical modifications are highlighted. Reports without controls of laparoscopic cholecystectomy for acute cholecystitis suggest that it is safe, while data with controls are scarce. Studies that compared the laparoscopic approach with the open approach found a similar major complication rate, but postoperative recovery was better after laparoscopy. However, studies that compared laparoscopic cholecystectomy for inflamed gallbladders with noninflamed gallbladders showed an increased risk of common bile duct injury in the former. Laparoscopic cholecystectomy may be attempted in acute cholecystitis provided the surgeon is experienced.