Outcomes of emergency laparoscopic cholecystectomy in patients with a complicated course of disease accompanied by nonspecific reactive hepatitis and obstructive jaundice

Objective: to improve the immediate outcomes of treatment in patients undergoing emergency laparoscopic cholecystectomy in the presence of reactive hepatitis and jaundice.

Material and methods: this study analyzed clinical data from 95 patients with acute calculous cholecystitis (ACC) complicated by nonspecific reactive hepatitis and jaundice. To compare diagnostic approaches and treatment strategies, two groups were defined. The main group consisted of 55 (57.9%) patients managed prospectively using contemporary diagnostic methods and clinical algorithms adopted at the study center. The control group comprised 40 (42.1%) patients whose records were analyzed retrospectively; these patients were treated according to standard protocols. Most patients (n = 89; 93.7%) sought specialized medical care more than 24 hours after the onset of biliary colic.

Results: in the main group, the surgical approach depended on the type of inflammatory process. In patients with catarrhal cholecystitis (n = 5), laparoscopic cholecystectomy starting at the gallbladder neck was performed in all cases. In patients with phlegmonous cholecystitis (n = 14), dissection starting at the neck was feasible in 7 cases (50.0%), whereas in 6 patients (42.8%), because of marked inflammatory infiltration in this region, a fundus-first laparoscopic cholecystectomy was required. In 1 patient (7.2%), laparoscopic cholecystectomy using the Pribram technique was performed based on intraoperative findings. Mean operative time was 37.1 ± 2.9 min and 39.3 ± 1.6 min, respectively. In the control group, cholecystectomy starting at the neck was performed in 7 patients (17.5%), while a fundus-first approach was used in 6 patients (15.0%). Postoperative analysis showed that, in the control group, complications after open surgery developed in 9 patients (22.5%), and mortality was 7.5% (3 deaths). In the main group, the complication rate was lower, at 12.7% (7 cases), and mortality was 3.6% (2 deaths).

Conclusion: choosing the laparoscopic cholecystectomy technique according to the pattern of gallbladder wall destruction allows the surgical strategy to be aligned with the severity of the inflammatory-destructive changes and the severity of the associated comorbidity.

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