Laparoscopic Cholecystectomy A Promising Surgical Option in the Management of Gallbladder Empyema

Abstract

ABSTRACT
Background: Laparoscopic cholecystectomy has become a treatment of choice as an
elective procedure for uncomplicated cholelithiasis but controversy persists regarding its
use in the treatment of complicated gall stone disease like empyema of the gallbladder
which is the severe form of acute cholecystitis with superadded suppuration (suppurative
cholecystitis).
Objective: To evaluate the safety and feasibility of laparoscopic cholecystectomy in the
management of empyema of the gall bladder.
Methods: From April 2011 to January 2014, 37 patients with empyema gallbladder out of
87 patients presented with clinical features of acute cholecystitis were treated by initial
conservative management for 72 hours followed by laparoscopic cholecystectomy. The
procedure was performed by the standard four-port technique with some technical
modifications to facilitate the surgical dissection according to the operative findings.
Results: Laparoscopic cholecystectomy was performed for 37(42.52%) patients with
empyema of gallbladder during the study period. Average operating time was 90 min,
conversion rate was 10.8%, and postoperative complications 21.62%, postoperative
hospital stays were 4 days.
Conclusion: Laparoscopic cholecystectomy in empyema of gallbladder is safe, effective
and valid alternative to conventional open cholecystectomy. It has a low rate of
complications and offers the patients a more comfortable postoperative period than open
cholecystectomy. Conversion rate is improving as surgeons gain more experience.