Purpose: Laparoscopic cholecystectomy has become the surgical modlity of choice for most symptomatic cholelithiasis. acute cholecytitis have been considered a relative contraindication because of increased complication rate & conversion
rate.
this study would be help that defined risk factor done early making dicison to open conversion.
Patient & Methods: We retrospectively reviewed the medical recored of 400 cases preoperatively diagnosed acute cholecystitis at Wonkwang medical center from Jun. 1995 to Dec. 2001. The cases were divided into 2 group based on surgical
modality-laparoscopic cholecystectomy & open conversion. Each group was evaluated preoperative status with age, sex, symptom duration, laboratory value, delayed time for diagnosis befor operation, combined disease previous biliary symptom and
postoperative findings that are acute cholecystitis type(sime cholecystitis, complicated cholecystitis) and liver grossly abnormal finding (fatty liver, chronic liver disease finding).
Results: 384 cases who were diagnosed acute cholecystitis as definded condition, except open cholecystectomy cases, 263 cases were performed laparoscopic cholecystectomy, 86 cases open conversion. In univariant analysis of preoperative &
intrapoperative factor, high frequency of conversion in acte cholecystitis were male, age( ≥ 60 year), delayed time before operation (≥ 48 hour) of preoperative factors (p<0.05) and complicated acute cholecystitis type (specially empyema type),
chronic liver disease finding of intrapoperative factors. (p<0.05) Five parameters were found to significant effect in multivariant analysis. Above five parameter were improved as independent significant risk factor(p<0.05) and as more signicant
independenr factor - male. delayed time before operation and complicated acute cholecystitis.(p<0.001)
Conclusions: Laparoscopic management of acute cholecystitis is feasible and safty when compared open cholecystectomy. Considering the factor discussed above, we will do early making dicison from laparoscopic cholecystectomy to open
conversion.
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