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. 2025 Jan-Mar;29(1):e2024.00061.
doi: 10.4293/JSLS.2024.00061. Epub 2025 Apr 8.

Evaluating Surgical Outcomes in Acute Cholecystectomies

Illés Tóth  1 , Ria Benkő  2 , Mária Matuz  2 , Dániel Váczi  1 , László Andrási  1 , László Libor  1 , János Tajti Jr  1 , György Lázár  1 , Szabolcs Ábrahám  1
Affiliations

Evaluating Surgical Outcomes in Acute Cholecystectomies

Illés Tóth et al. JSLS. 2025 Jan-Mar.

Abstract

Background and objectives: This study aimed to identify the predictors of surgical outcomes in acute cholecystitis (AC).

Methods: Patients undergoing cholecystectomy for AC between January 1, 2007 and December 31, 2019 at a single center were retrospectively reviewed. Conversion rate (CR), laparoscopic success rate (LSR), mortality, and bile duct injury (BDI) were evaluated in light of sex, age, ultrasound morphological diagnoses, severity of cholecystitis, performance status, time frame, and introduction of percutaneous transhepatic gallbladder drainage (PTGBD).

Results: A total of 465 patients underwent early cholecystectomy. CR and LSR were 16.89% and 78.28%, respectively; the mortality rate was 1.62%. Increased severity of cholecystitis (grade I vs II vs III) was associated with increased mortality (1.17 vs 2.27 vs 8.33%, P = .183) and CR (7.09 vs 32.93 vs 28.57%, P < .001) and decreased LSR (91.11 vs 61.11 vs 38.46%, P < .001). Surgery within 72 hours had lower mortality (1.41 vs 2.6%, P = .613) with significantly lower CR (14.45 vs 25.71%, P = .008) and higher LSR (81.69 vs 67.53%, P = .008) compared to surgery after 72 hours. Mortality (0 vs 0.92 vs 6.19%, P = .001) and CR (4.2 vs 16.27 vs 39.53%, P < .001) increased with an increase in Charlson comorbidity index (CCI), while LSR decreased (95.8 vs 79.91 vs 50.49%, P < .001).

Conclusion: CCI and the severity of cholecystitis had the strongest influence on CR and LSR. Cholecystectomies performed within 72 hours were associated with reduced CR and increased LSR. PTGBD is a viable treatment option in elderly high-risk patients.

Keywords: Acute cholecystitis; Conversion rate; Early cholecystectomy; Gallbladder drainage; Laparoscopic cholecystectomy; Percutaneous transhepatic.

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Figures

Figure 1.
Figure 1.
Number of percutaneous transhepatic gallbladder drainage (PTGBD) procedures per year and the annual LSR of the early/urgent cholecystectomies for acute cholecystitis from 2007–2019. LSR, laparoscopic success rate (number of LCs/total number of operations).
See this image and copyright information in PMC

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