The acute cholecystitis: The operative timing for the laparoscopic approach.

Abstract

The aim of this study is to evaluate the results of early cholecystectomy in patients with acute cholecystitis.

In the past, acute cholecystitis was a controindication to laparoscopic cholecystectomy because of the greater risk of injury to the biliary duct, but acute gallbladder inflammation was a contraindication to open cholecystectomy, too.

With greater experience and new technology, laparoscopic cholecystectomy is today the gold standard in the treatment of acute cholecystitis, in empyema and gangrenous cholecystitis.

In last years, attention move into surgical timing, rather than surgical management - open versus laparoscopy - because there is no advantage in delaying cholecystectomy for acute cholecystitis.

In our experience, we always choose laparoscopic technique in all the patients without general controindications to miniinvasive surgery and operate as soon as possible in patient under favourable conditions.

We believe that the patient early must be quickly stabilized with medical preoperative procedures and surgical treatment must be performed within 72-96 hours after the onset of symptoms.

In the space of this hours, laparoscopic approach allows a reduction of operative time, operative risk and the conversion rate with medical and economic advantages.