The Impact of the Number and Size of Gallstone on the Suppuration of Gallbladder and Conversion Rate to Open from Laparoscopic Cholecystectomy

Ahn, Jae Seok; Kim, Yong Hoon; Kang, Koo Jeong; Lim, Tae Jin

Abstract

BACKGROUND/AIMS: The progression of the inflammation to suppurative cholecystitis may depend on the number and size of gallstone. This is a comparative study of correlation between the nature of gallstone (number and size) and progression of suppurative cholecystitis and effect to the difficulty in surgery.
METHODS
We analyzed 1,235 patients who were treated with laparoscopic cholecystectomy for the gallstone disease including acalculus cholecystitis and acute suppurative cholecystitis with or without gallstones. One hundred and twenty nine patients were acute suppurative cholecystitis. The patients were grouped four arms according to the size of stones as follows; group I has no stone, group II <1 cm, 1 cm or =2 cm. Also the patients were grouped to four groups according to the number of stones; group A has no stone, 1< or =group B< or =3, 4< or =group C< or =6 and group D> or =7.
RESULTS
Conversion rate to open laparotomy was 17.1% (22/129). In case of suppurative cholecystitis, six patients were included in arm I, 57 patients in arm II, 35 patients in arm III, nine patients in arm IV. And six patients were included in group A, 44 patients in group B, three patients in group C and 54 patients in group D of laparoscopic cholecystectomy. Of the 22 patients who were converted to open cholecystectomy, one patient was included in arm I, 14 patients in arm II, four patients in arm III, three patients in arm IV. And one patient was included in group A, eight patients in group B, one patient in group C and 12 patients in group D of open conversion group. There was no statistical significance of the groups (p>0.05). The mean size of stones of the patients with suppurative cholecystitis (129 patients) and simple cholecystitis patients (312) was 0.97 versus 0.91 cm (p>0.05). There was no statistical difference of the number and size of gallstones between simple and suppurative cholecystitis (p>0.05).
CONCLUSION
The number and size of gallstone for the patients who were treated by cholecystectomy was not contributing factors to develope suppurative cholecystitis and conversion to open from laparoscopic cholecystectomy.