[Laparoscopic cholecystectomy in acute cholecystitis. Experiences with 20 cases].

With the experience of 80 cases of laparoscopic cholecystectomy, we started to operate all gallbladders by the laparoscopic way, even if there was the diagnosis of an acute cholecystitis. Between May 1991 and January 1992, 20 patients with acute cholecystitis have been operated by laparoscopic surgery. The patients' ages varied from 21 to 75 years (mean 53 years). The preoperative evaluation of the biliferous ducts, especially in case of cholestasis, should give a precise diagnosis of anatomic variations or stones. Therefore the ERCP as an additional preoperative examination was necessary in 10 (50%) cases. 14 (70%) could be operated by the laparoscopic way without surgical complications. In 6 patients closed procedures had to be changed to open cholecystectomy because of the following reasons: Scars and uncertainty about the anatomy in Calot's triangle (4x), severe adhesions to the colon (1x), and perforation of a gallbladder with necrotic wall, respectively. The good results, the possibility of a direct view of the situs, and the fact that anytime during the operation a change to the open procedure is possible, are reasons to start all cholecystectomies by the laparoscopic manner.