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Laparoscopic cholecystectomy(LC) has been accepted as the procedure of choice for chronic cholecystitis. But in the cases of acute cholecystitis, the safety and efficacy of LC has not been fully determined. So we performed this study to assess the clinical outcomes of LC in the cases of acute cholecystitis to evaluate it´s efficacy and safety. The author analyzed 1,164 cases of LC performed in YUH from May 1991 to March 1996 retrospectively. Among 1,164 cases, 118 cases of LC were performed for acute cholecystitis and 1,046 cases of LC were performed for chronic cholecystitis. The author compared the mean operation time, conversion rate to open cholecystectomy(OC), reasons for conversion, complication rate, postoperative hospital stays, postoperative uses of analgesics between the patients with acute cholecystitis and the patients with chronic cholecystitis. In 1046 patients with chronic cholecystitis, mean operative time was 55.9 minutes, conversion rate to OC was 2.7%, complication rate was 4.0%, mean postoperative hospital stay was 3.3 days and analgesics were used in 48% of the patients. But in 118 patients with acute cholecystitis, mean operation time was 65 minutes, conversion rate to OC was 11.8%, complication rate was 16.9% mean hospital stay was 4.4 days and analgesics were used in the 60% of patients. And also the author found that the longer preoperative symtom durations and the advanced state of inflammation(eg:GB empyema, ganrenous changes) were two most common cause of conversion to OC in the case of acute cholecystitis. Although all analyzed parameters(esp. conversion rate and complication rate) were higher in the patients with acute cholecystitis than those of the patients with chronic cholecystitis, LC in acute cholecystitis seems to be acceptable because there was neither mortality nor life threatening complications. In the aspects of safety and efficacy, LC can be perforned in most patients with acute cholecystitis. But it should be remembered that the prolonged duration of symptoms prior to LC increases the conversion rate to O.C. and if we confront the advanced cholecystitis(GB empyema or gangreous change) with difficult Calot´s triangle during L.C., early conversion to OC should be considered.
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