Abstract
<Background> In selecting cholecystectomy for cholecystolithiasis, the most favored option is laparoscopic cholecystectomy (LC) according to the ldquo;Tokyo guidelines.” In cases that involve high grade inflammation, however, surgery should be converted to open laparotomy (OL) before complications occur. Further, according to the ldquo;Clinical Guidelines for Acute Cholecystitis,” the levels of white blood cells (WBC), CRP, bilirubin, urea nitrogen (UN), creatinine, and hepatobiliary enzymes (AST and ALT) are useful for determining the severity of cholecystitis. An emergency operation is suggested for severe cases, whereas early-stage LC is advised for mild cases. In this study, we retrospectively reviewed acute cholecystitis cases encountered at our department. <Methods> Among the 586 cases of cholecystectomy carried out between April 2000 and November 2011, 212 cases had moderate cholecystitis. These cases were divided into the LC completion group (LC group; n=186) and conversion to OL group (OL group; n=26). <Results> The mean ages of patients in the LC and OL groups were 55.0 and 60.9 years (p=0.06); the median operation times were 135.2 and 202.0 minutes, (p<0.05); the median operative blood loss was 47.5 and 246.0mL (p<0.05), postoperative hospitalization was 3.3 and 9.5 days (p<0.05), preoperative WBC count was 7,500 and 11,200/μL (p<0.05), CRP was 3.4 and 8.8mg/dL (p<0.05), bilirubin was 1.2 and 2.2mg/dL (p=0.12), UN was 13.7 and 16.1mg/dL (p=0.06), creatinine was 0.78 and 0.75mg/dL (p=0.69), AST was 49.3 and 206.4 U/I (p<0.05), ALT was 64.0 and 181.7U/L (p<0.05), ALP was 318.7 and 484.2U/L (p=0.09), γGTP was 112.8 and 316.3U/L (p<0.05), and time elapsed from onset of cholecystitis to surgery was 72.5 and 578.9 hrs (p<0.05), respectively. Multivariate analysis revealed a significant difference (p<0.05) in time elapsed from the onset of cholecystitis to surgery (cutoff at 72 hrs). <Conclusions> Cases with 72 or more hours' relapse from onset of cholecystitis to surgery entailed a high potential for converting to OL.
