Question

Outcome of lap chole in acute gangrenous cholecystitis

Answer 1

Answer:

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Mortality was higher in cases in which conversion to open surgery occurred, which might be ascribed to the fact that laparoscopic cholecystectomy was undertaken in selected patients with less-severe inflammatory status.

Answer 2

Answer:

As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21–88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

Key words: Gangrenous cholecystitis, Cholecystectomy, mortality

Gangrenous cholecystitis (GC) is defined as necrosis and perforation of the gallbladder wall as a result of ischemia following progressive vascular insufficiency.1,2 GC is a severe complication of cholelithiasis.3,4 Factors such as male sex, advanced age, delayed surgery, leukocytosis, cardiovascular diseases (CVDs), and diabetes mellitus (DM) increase the likelihood of developing GC.3,5–8 Compared with uncomplicated acute cholecystitis, GC carries a significantly higher mortality rate, which has been reported to be between 15% and 50%.3,4 We aimed in this study to specify the risk factors affecting mortality in patients with GC who underwent surgery.