PURPOSE: Since introduction of the laparoscopic procedure for cholecystectomy, it has become the treatment of choice for symptomatic gallbladder diseases. Previous studies have demonstrated that implementation of critical pathway (CP) in laparoscopic cholecystectomy (LC) is effective in reducing cost in terms of length of stay (LOS) and revisit rates. However, few studies have proven the effectiveness of critical pathway specifically in patients with acute cholecystitis (AC). METHODS: CP was introduced for LC for chronic cholecystitis (CC) in April 2008. Then, indication for CP was extended to AC in May 2010. We compared outcomes of LC for patients with AC between two eras, including Pre-CP (Jan 2007 to Mar 2008) and Post-CP (May 2010 to Jun 2011). Among 78 patients with AC, 70 patients (90%) were enrolled for the critical pathway. Among them, 55 patients (79%) were discharged with full application of CP; however, it was suspended in 15 patients (21%). RESULTS: No differences in demographics and clinical characteristics were observed between Pre-CP (n=97) and Post-CP (n=70) patients. The mean LOS before surgery was shorter in the Post-CP group (2.6 vs. 4.0 days, p=.012). In addition, the mean total LOS was shorter in the Post-CP group (5.5 vs. 8.7 days, p<.001). However no differences in postoperative complications were observed between the two groups (10 vs. 5 cases, p=.483). CONCLUSION: Implementation of CP in AC resulted in a decrease in the LOS in total and before surgery, without increasing morbidity. Therefore, critical pathway can be safely implemented for selected patients with AC.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Critical Pathways* ; Demography ; Gallbladder Diseases ; Humans ; Length of Stay ; Postoperative Complications

PURPOSE: Operative management of acute cholecystitis in aged patients has been shown to have relatively higher morbidity and mortality. The aim of this study was to determine appropriate management protocols for acute cholecystitis in those more than 70 years old. METHODS: From May 2003 to Dec 2009, we performed this study of patients over 70 years old that were diagnosed with acute cholecystitis (n=257). We excluded patients that had a hepatobilliary malignancy, a previous laparotomy history, secondary cholecystitis, or a high operative risk factor (n=78). Eligible participants were divided into two groups according to the first management of acute cholecystitis. One hundred two of the 179 (group A) had undergone a laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) within 48 hr after arriving at the emergency room; 77 of the 179 (group 2) had PTGBD done as the first management protocol. We divided group 2 into group C (n=47) and D (n=30) according to cholecystectomy or not. We compared clinical outcomes of the two groups. RESULTS: The mean age of patients was 77.5 years old (102 for Group A and 77 for Group B. Univariant analysis of pre-operative clinical findings between groups A and B showed a significant difference only in age and in type of acute cholecystitis, However, the pre-operative co-morbidity of group B was significantly higher than that for group A. Comparing postoperative results between groups A and C, postoperative complications, open conversion rate, and mortality after cholecystectomy were not significantly different. CONCLUSION: PTGBD could be considered as appropriate management in aged patients with acute cholecystitis. Moreover, PTGBD can reduce unnecessary cholecytectomies.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Emergencies ; Gallbladder ; Humans ; Laparotomy ; Postoperative Complications ; Risk Factors

PURPOSE: This study was to evaluate the safety and conversion rate of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in patients with a complicated acute cholecystitis (GB empyema, gangrenous cholecystitis and pericholecystic abscess) according to the timing of LC. METHODS: One hundred and four patients, who underwent a laparoscopic cholecystectomy after PTGBD between March 2004 and December 2006, were analyzed. Thirty-four patients underwent LC within 7 days after PTGBD (early group, n=34) and 38 patients underwent LC between 14 and 39 days after PTGBD (delayed group, n=38). Thirty-two patients were excluded because of gallbladder cancer (n=2), simple acute cholecystitis (n=12), a history of previous abdominal surgery (n=5), and LC between 8 and 13 days after PTGBD (n=13). RESULTS: There was no significant difference in age (early group, 58.4+/-11.2; delayed group, 61.0+/-12.1), diagnosis, duration of symptoms, WBC counts, interval of admission and PTGBD, improvement of symptoms after PTGBD, American Society of Anesthesiologists (ASA) score, prior medical history, post-PTGBD and postoperative complications, and operation time. The rate of conversion to an open laparotomy was 14.7% (5/34) in the early group and 2.6% (1/38) in the delayed group (statistically not significant). CONCLUSION: The timing of LC after PTGBD for a complicated acute cholecystitis does not influence the rate of conversion to an open laparotomy, surgery time and complication. However, a delayed LC after PTGBD tends to decrease the rate of conversion to an open laparotomy.
Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Diagnosis ; Drainage* ; Empyema ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Laparotomy ; Postoperative Complications

PURPOSE: The laparoscopic cholecystectomy has increasingly been accepted as the procedure of choice for treatment of symptomatic gall stones and chronic cholecystitis. However, its role and its timing in the management of patients with acute cholecystitis remain controversial. This retrospective study was undertaken to compare on early laparoscopic cholecystectomy with a delay one for patients with acute cholecystitis. METHODS: Between January 1995 and June 1999, 15 patients were operated on within 72 hours of symptom onset. Those patients were classified as the early laparoscopic cholecystectomy group. The 18 patients who underwent a delayed laparoscopic cholecystectomy after a percutaneous transhepatic cholecystostomy (PTCS) and conservative management were classified as the delayed laparoscopic cholecystectomy group. RESULTS: No significant differences were seen in the conversion rate (1 case in the delayed group), the operation time (early group 107.3 min., delayed group 118.6 min.), postoperative complications (early group 20.0%, delayed group 16.7%), and the postoperative hospital stay (early group 4.7 days, delayed group 7.1 days). The early group had significantly more frequent operation modifications and decreased total hospital stays than the delayed group: 86.7% and 7.0 days, for the early group and 44.4% and 22.8 days for the delayed group. CONCLUSION: Early laparoscopic cholecystectomy for acute cholecystitis did not increase the operation time, the morbidity, or the conversion rate. Although this study was not a randomized study and the sample size was small, an early laparoscopic cholecystectomy seems to be safe and feasible for patients with acute cholecystitis, having the benefit of a decreased total hospital stay.
Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Cholecystostomy ; Gallstones ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Sample Size

Xanthogranulomatous cholecystitis (XGC) is known to be a rare, variant type of chronic cholecystitis and more frequently found in the adults with a prevalence of 0.7 to 13.2% of all cholecystitis, moreover very rare in children. Clinically, this usually presents as chronic or acute cholecystitis associated with gallstones, but biliary colic is unusual. Although it requires surgery for management, it may accompany some difficulties during cholecystectomy and postoperative complications such as biliary fistula. It could also give rise to higher conversion rates than other diseases of the gallbladder during laparoscopic procedures. We experienced a very rare pediatric case of xanthogranulomatous cholecystitis not associated with gallstones, successfully managed by laparoscopic cholecystectomy and hereby report it with literature reviews.
Adult ; Biliary Fistula ; Child ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Colic ; Gallbladder ; Gallstones ; Granuloma ; Humans ; Postoperative Complications ; Prevalence ; Xanthomatosis

PURPOSE: Laparoscopic cholecystectomy (LC) has been standard in the treatment of uncomplicated symptomatic gallstone disease, but it has been limited for the management of more complicated cholecystitis because of technical difficulties, high conversion rate and postoperative complication rate. Percutaneous gallbladder drainage (PGBD) could been a feasible option for successful LC in patients with acute complicated cholecystitis. Optimal timing of successful LC in acute complicated cholecystitis have been controversy. Aim of this study is to evaluate clinical usefulness of PGBD and optimal timing of successful LC for acute complicated cholecystitis, which is to determine whether PGBD can reduce the conversion or complication rate and shorten the operative time or postoperative hospital stay and timing of LC. METHODS: We retrospectively reviewed the medical records of total 230 patients underwent LC for acute cholecystitis during Jan.1994-March 2005 at DongKang hospital. We divided 2 groups patients into complicated cholecystitis and cholecystitis, Which were subdivided each into PGBD and non-PGBD group by whether PGBD performed and PGBD subdivided into the early LC. RESULTS: Summarized results described above firstly non- PGBD complicated cholecystitis showed higher conversion rate and postoperative complication rate and longer OP. time compared to PGBD group, secondly following PGBD, delayed LC have advantages of lower conversion rate and complication rate and shorter OP. time compared to early LC group. CONCLUSION: PGBD for LC is safe and effective method to immediate LC in the management of acute complicated cholecystitis. Delayed LC after PGBD would be best option of management for acute complicated cholecystitis.
Cholecystectomy, Laparoscopic* ; Cholecystitis* ; Cholecystitis, Acute ; Drainage* ; Gallbladder* ; Gallstones ; Humans ; Length of Stay ; Medical Records ; Operative Time ; Postoperative Complications ; Retrospective Studies

PURPOSES: A laparoscopic cholecystectomy has many clinical advantages and is now recognize as the choice of treatment for gallstones. However a laparoscopic cholecystectomy is often not feasible or is converted to the conventional open method in patients with acute cholecystitis because of inflammation around the gallbladder, surrounding adhesion, unclear anatomy, or intraoperative complications, such as excessive bleeding, bile duct and other organ injury, or other technical problems. Recent studies recommended that acute cholecystitis patients or gallbladder empyema patients with pain undergo a cholecystostomy first and a laparoscopic cholecystectomy later because a cholecystostomy can be very helpful for improving the patient's state: for example, gallbladder decompression, early control of acute inflammation, and alleviating gallbladder adhesion alleviation. METHODS: This study was carried out on 62 patients (Group I) who underwent a laparoscopic cholecystectomy after a percutaneous cholecystostomy at EulJi Medical College between January 1996 and March 2000. These cases were compared with a control group of 41 patients (Group II) who showed similar symptoms, ultrasonographic findings, operative findings, and pathologic results before January 1996 when a cholecystostomy was not yet used at this hospital. RESULTS: Among Group I, a successful laparoscopic cholecystectomy was possible in 40 patients (64.5%), the other 22 patients were converted to open cholecystectomy. In Group II, only 15 patients (36.6%) out of 41 underwent a successful laparoscopic cholecystectomy. This difference was statistically significant (p=0.005). In other words, the open conversion rates were 35.5% in Group I and 63.4% in Group II. There were no differences in the age and the sexdistributions, the symptom duration, Alk-phosphatase, total bilirubin, and leucocytosis. The degree of inflammation didn't have a singificant influence. Neither did the gallbladder wall thickness. CONCLUSION: We think that a laparoscopic cholecystectomy perfomed some time after a percutaneous cholecystostomy to improve the patient's condition by eliminating acute inflammation or decompressing the gallbladder may be recommended for management of acute cholecystitis patients with severe clinical symptoms and ultrasonographic findings of marked gallbladder dilatation or pericholecystic fluid collection.
Bile Ducts ; Bilirubin ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute ; Cholecystostomy* ; Decompression ; Dilatation ; Gallbladder ; Gallstones ; Hemorrhage ; Humans ; Inflammation ; Intraoperative Complications

Acalculous Cholecystitis ; microbiology ; Adult ; Cholecystitis, Acute ; diagnosis ; microbiology ; Enzyme-Linked Immunosorbent Assay ; Humans ; Leptospirosis ; complications ; diagnosis ; Male ; Pancreatitis ; etiology ; microbiology

A biloma is an encapsulated bile collection outside the biliary tree. Most cases of biloma are caused by iatrogenic injury or trauma. Intrahepatic rupture of the biliary tree due to nontraumatic cause is a rare event. A 68- year-old man was admitted because of abdominal pain and fever. He had no past history of abdominal surgery, instrumentation or trauma. Computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) demonstrated a large subcapsular fluid collection in the right liver associated with choledocholithiasis and cholecystitis. Biloma was confirmed by sono-guided percutaneous needle aspiration and was drained through a pigtail catheter. After the successful treatment by percutaneous drainage and endoscopic sphincterotomy, the patient recovered. Here, we report an uncommon case of spontaneous biloma formation in association with choledocholithiasis with a review of literatures.
Aged ; *Bile ; Cholecystitis/*complications/diagnosis ; Choledocholithiasis/*complications/diagnosis ; English Abstract ; Humans ; Male

Child ; Cholecystitis, Acute ; complications ; diagnosis ; Comorbidity ; Hepatolenticular Degeneration ; complications ; diagnosis ; Humans