Laparoscopic Management Of Patients With Acute Biliary Symptoms
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Laparoscopic cholecystectomy has become the standard elective man agement of cholelithiasis. Little Information exists, however, regarding the appropriateness of this procedure in the setting of acute symptomatol ogy. We reviewed our results with 26 patients with acute biliary symp toms managed laparoscopicahy. There were 18 females and 8 males with their ages ranging from 22 to 70 years with an average of 46 years. Laparoscopic cholecystectomy was attempted in all patients, and was succesfui in 22 of 26 patients, four procedures were converted to open cholecystectomy because of diffi culty in dissection precluding laparoscopic cholecystectomy. Patients requiring open cholecystectomy were older, more likely to be febrile (mean temperature of 37.9+ 0.6 versus 37+0.7 C)and were more likely to have a significant leukocytosis frneon white cell Count 12.8 5.2 xlO3 cells/mm3 versus 9.22.8xlO3 cells/mm3) than were those under going succesjul laparoscopic cholecystectomy. Laparaoscopic cholecystectomy can be performed safely in the majority of patients presenting with acute biliary symptoms. Patients presenting • with a triad of right upper quadrant pain, fever and elevated white cell count who are especlaly males, elderly and morbidly obese are more like ly to require covrersion to a standard cholecystectomy and should be in formed accordingly.