EARLY VERSUS DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS

Acute cholecystitis isthe most common acute disease in hepatobiliary surgery and one of the mostcommon diseases in digestive tract surgery in general (1). With aging, theincidence increases from 4% in the third decade to 27% in the seventh decade oflife (2). Biliary calculosis is undoubtedly a disease of modern man. At least20% of the human population is thought to have cholelithiasis but inthe most developed countries of the world this percentage is higher. The factis that this disease is much more common in areas where the diet is irrational(fat-rich and high- calorie diet).

The incidence of thedisease increases with age.

Women of childbearing age are more likely to suffer than men(1.5-3.0:1). There is a 4F formula that is attractive but does not explain themechanism and occurrence of biliary calculosis (female, forty, fat andfertile). It should also be known that almost 50% of biliary lithiasis isasymptomatic and is detected accidentally during some clinical trials. Cholecystectomy is method of choicefor treatment of gallbladder calculosis.Open cholecystectomy has been the “gold standard†for symptomatic cholelithiasisfor a century. However, in the last two decades the introduction oflaparoscopic cholecystectomy has revolutionized the treatment of gallbladdercalculosis (4).

Laparoscopic cholecystectomy is nowconsidered to be the procedure of choice that achieves a shorter recoveryperiod and reduced treatment costs. In earlier years acute cholecystitis wasregarded as a relative contraindication for laparoscopic cholecystectomybecause of inflammatory changes that impair tissue quality and make it difï¬cultto accurately visualize anatomical structures.

As technological advances have beenaccompanied by improvements in surgical performance laparoscopy has become the“gold standard†in the treatment of chronic cholecystitis with cholelithiasis,and over time the indications widen and acute gallbladder inflammation is alsoresolved by laparoscopy.