Indications for emergent laparoscopic or open cholecystectomy

Laparoskopska kolecistektomija operacija je koja je prvi put izvedena 1985. godine i od tad pa do danas postepeno zamjenjuje otvorenu (klasičnu) kolecistektomiju kao terapiju akutnog kolecistitisa. Mnoštvo znanstvenih radova prikazuje laparoskopsku kao bolju kiruršku metodu. Prva laparoskopska kolecistektomija u Hrvatskoj izvedena je 1992. godine. U ovom radu analizirani su pacijenti koji su bili primljeni preko hitne službe Kliničkog bolničkog centra Zagreb i podvrgnuti kolecistektomiji u razdoblju od dvije godine (2016./2017.). Uspoređivan je odnos između otvorene i laparoskopske metode, njihov broj, učestalost komplikacija (intraoperativnih i postoperativnih), trajanje hospitalizacije i učestalost konverzija. Uzeti su u obzir i komorbiditeti onih pacijenata kod kojih se odmah odlučilo za otvorenu metodu. Operirano je ukupno 284 pacijenata, od kojih 184 (64,8%) laparoskopski, 59 (20,8%) otvorenom metodom, a u ostalih 41 (14,4%) učinjena je konverzija. Analizom podataka o komplikacijama prilikom i nakon operacije, a isto tako i trajanja hospitalizacije, odgovor na pitanje o indiciranosti i odabiru metode je naizgled jednostavan: laparoskopska metoda puno je sigurnija i bolja za pacijenta i kao takva uvijek bi trebala imati prednost nad otvorenom, osim u slučaju kada postoje kontraindikacije (navedene u literaturi) među kojima su plućne i srčane bolesti, prijašnje operacije i velike upale u abdomenu, ciroza jetre, a isto tako i nedostatak opreme i nekvalificiranost osoblja.Laparoscopic cholecystectomy surgery was first performed in 1985 and since then it has gradually replaced open (classical) cholecystectomy as an acute cholecystitis therapy. A lot of scientific papers show laparoscopy as the better surgical method. The first laparoscopic cholecystectomy in Croatia was performed in 1992. This paper analyzes the patients who were admitted via the Emergency Department of the University Hospital Center Zagreb and underwent cholecystectomy in a two-year period (2016/2017). The relationship between open and laparoscopic methods, their number, complication frequency (intraoperative and postoperative), hospitalization time, and conversion frequency were compared. Comorbidities of patients who underwent open cholecystectomy without conversion were also considered. A total of 284 patients underwent surgery out of which 184 were laparoscopies (64.8%), 59 open surgeries (20.8%), and in 41 (14.4%) the procedure was converted. By comparing the data on complications during and after surgery, as well as the hospitalization length, the answer to the question of indications for each method is simple, as well as the choice of method: the laparoscopic method is much safer and better for the patient, and as such should be performed whenever there are no contraindications (listed in the literature) such as: pulmonary and cardiovascular diseases, previous abdominal surgeries and severe inflammation of the abdomen, liver cirrhosis, as well as equipment shortage and staff inadequacy