Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases

Hung-Chieh Lo, Yu-Chun Wang, Li-Ting Su, Chi-Hsun Hsieh

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Gallbladder perforation is a rare but serious complication of cholecystitis. It was usually managed by percutaneous gallbladder drainage (PTGBD) followed by elective cholecystectomy. However, evidences are emerging that early laparoscopic cholecystectomy (LC) is still feasible under these conditions. We hypothesized that early LC may have comparable surgical results as to those of PTGBD + elective LC. Material and methods: From January 2005 to October 2011, patients admitted to China Medical University Hospital with a diagnosis of perforated cholecystitis were retrospectively reviewed. The diagnosis of gallbladder perforation was made by image and/or intraoperative findings. Those patients who had unstable hemodynamics that were not fitted for general anesthesia or those who had concomitant major operations were excluded. Patients were divided into three groups: early open cholecystectomy (group 1), early LC (group 2), and PTGBDfollowed by elective LC (group 3). The demographic features, surgical results, and patient outcome were analyzed and compared between groups. Results: A total of 74 patients were included. All patients had similar demographic features except that patients in group 2 were younger (62 vs. 72 and 73.5 years) compared with group 1 and group 3 (p = 0.016). There were no differences in terms of operative time, blood loss, conversion, and complication rate between three groups. The length of hospital stay (LOS) was significant shorter in group 2 patients compared with that of groups 1 and 3. Conclusions: Although PTGBD followed by elective LC was still the mainstay for the treatment of gallbladder perforation, early LC had comparable surgical outcomes as that of PTGBD + LC but with a significantly shorter LOS. Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD + LC can be preserved for those who carried a high risk of operation. © Springer Science+Business Media, LLC 2012.
Original languageEnglish
Pages (from-to)3301-3306
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume26
Issue number11
DOIs
Publication statusPublished - 2012
Externally publishedYes

Fingerprint

Cholecystitis
Laparoscopic Cholecystectomy
Gallbladder
Drainage
Length of Stay
Cholecystectomy
Demography
Operative Time
General Anesthesia
China
Hemodynamics

Keywords

  • Cholecystectomy
  • Cholecystitis
  • Drainage
  • Laparoscopy
  • Perforation
  • adult
  • aged
  • cholecystectomy
  • cholecystitis
  • clinical effectiveness
  • controlled study
  • disease association
  • early intervention
  • elective surgery
  • female
  • gallbladder perforation
  • high risk patient
  • human
  • intermethod comparison
  • length of stay
  • major clinical study
  • male
  • operation duration
  • outcome assessment
  • percutaneous transhepatic drainage
  • postoperative hemorrhage
  • priority journal
  • retrospective study
  • review
  • surgical mortality
  • surgical risk
  • Aged
  • Aged, 80 and over
  • Cholecystectomy, Laparoscopic
  • Early Medical Intervention
  • Female
  • Gallbladder Diseases
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rupture, Spontaneous

Cite this

@article{df15158b593145bb9a261fce37a4edc6,
title = "Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases",
abstract = "Background: Gallbladder perforation is a rare but serious complication of cholecystitis. It was usually managed by percutaneous gallbladder drainage (PTGBD) followed by elective cholecystectomy. However, evidences are emerging that early laparoscopic cholecystectomy (LC) is still feasible under these conditions. We hypothesized that early LC may have comparable surgical results as to those of PTGBD + elective LC. Material and methods: From January 2005 to October 2011, patients admitted to China Medical University Hospital with a diagnosis of perforated cholecystitis were retrospectively reviewed. The diagnosis of gallbladder perforation was made by image and/or intraoperative findings. Those patients who had unstable hemodynamics that were not fitted for general anesthesia or those who had concomitant major operations were excluded. Patients were divided into three groups: early open cholecystectomy (group 1), early LC (group 2), and PTGBDfollowed by elective LC (group 3). The demographic features, surgical results, and patient outcome were analyzed and compared between groups. Results: A total of 74 patients were included. All patients had similar demographic features except that patients in group 2 were younger (62 vs. 72 and 73.5 years) compared with group 1 and group 3 (p = 0.016). There were no differences in terms of operative time, blood loss, conversion, and complication rate between three groups. The length of hospital stay (LOS) was significant shorter in group 2 patients compared with that of groups 1 and 3. Conclusions: Although PTGBD followed by elective LC was still the mainstay for the treatment of gallbladder perforation, early LC had comparable surgical outcomes as that of PTGBD + LC but with a significantly shorter LOS. Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD + LC can be preserved for those who carried a high risk of operation. {\circledC} Springer Science+Business Media, LLC 2012.",
keywords = "Cholecystectomy, Cholecystitis, Drainage, Laparoscopy, Perforation, adult, aged, cholecystectomy, cholecystitis, clinical effectiveness, controlled study, disease association, early intervention, elective surgery, female, gallbladder perforation, high risk patient, human, intermethod comparison, length of stay, major clinical study, male, operation duration, outcome assessment, percutaneous transhepatic drainage, postoperative hemorrhage, priority journal, retrospective study, review, surgical mortality, surgical risk, Aged, Aged, 80 and over, Cholecystectomy, Laparoscopic, Early Medical Intervention, Female, Gallbladder Diseases, Humans, Male, Middle Aged, Retrospective Studies, Rupture, Spontaneous",
author = "Hung-Chieh Lo and Yu-Chun Wang and Li-Ting Su and Chi-Hsun Hsieh",
note = "被引用次數:4 Export Date: 24 March 2016 通訊地址: Hsieh, C.-H.; Department of Trauma and Emergency Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan; 電子郵件: hsiehchihsun@yahoo.com.tw 參考文獻: Huang, C.C., Lo, H.C., Tzeng, Y.M., Huang, H.H., Chen, J.D., Kao, W.F., Yen, D.H.T., Lee, C.H., Percutaneous transhepatic gallbladder drainage: A better initial therapeutic choice for patients with gall bladder perforation in the emergency department (2007) Emerg Med J, 24, pp. 836-840; Kochar, K., Vallance, K., Mathew, G., Jadhav, V., Intrahepatic perforation of the gall bladder presenting as liver abscess: Case report, review of literature and Niemeier's classification (2008) European Journal of Gastroenterology and Hepatology, 20 (3), pp. 240-244. , DOI 10.1097/MEG.0b013e3282eeb520, PII 0004273720080300000017; Larmi, T.K.I., Kairaluoma, M.I., Junila, J., Perforation of the gallbladder. A retrospective comparative study of cases from 1946-1956 and 1969-1980 (1984) Acta Chirurgica Scandinavica, 150 (7), pp. 557-560; Menakuru, S.R., Kaman, L., Behera, A., Singh, R., Katariya, R.N., Current management of gall bladder perforations (2004) ANZ Journal of Surgery, 74 (10), pp. 843-846. , DOI 10.1111/j.1445-1433.2004.03186.x; Gurusamy, K., Samraj, K., Gluud, C., Wilson, E., Davidson, B.R., Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis (2010) Br J Surg, 97, pp. 141-150; Melloul, E., Denys, A., Demartines, N., Calmes, J.M., Schafer, M., Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: Does it matter? (2011) World J Surg, 35, pp. 826-833; Davis, C.A., Landercasper, J., Gundersen, L.H., Lambert, P.J., Effective use of percutaneous cholecystostomy in high-risk surgical patients: Techniques, tube management, and results (1999) Arch Surg, 134, pp. 727-731. , discussion 731-7222; Melin, M.M., Sarr, M.G., Bender, C.E., Van Heerden, J.A., Percutaneous cholecystostomy: A valuable technique in high-risk patients with presumed acute cholecystitis (1995) Br J Surg, 82, pp. 1274-1277; Derici, H., Kara, C., Bozdag, A.D., Nazli, O., Tansug, T., Akca, E., Diagnosis and treatment of gallbladder perforation (2006) World Journal of Gastroenterology, 12 (48), pp. 7832-7836; Stefanidis, D., Sirinek, K.R., Bingener, J., Gallbladder perforation: Risk factors and outcome (2006) J Surg Res, 131, pp. 204-208; Mocharla, R., Shah, H.R., Gallbladder perforation with contained empyema diagnosed by CT but missed by sonography and hepatobiliary scintigraphy (1997) Am J Roentgenol, 168, pp. 283-284; Fletcher Jr., A.G., Ravdin, I.S., Perforation of the gallbladder (1951) Am J Surg, 81, pp. 178-185; Strasberg, S.M., Hertl, M., Soper, N.J., An analysis of the problem of biliary injury during laparoscopic cholecystectomy (1995) J Am Coll Surg, 180, pp. 101-125; Ido, K., Isoda, N., Kawamoto, C., Suzuki, T., Ioka, T., Nagamine, N., Taniguchi, Y., Kimura, K., Confirmation of a {"}safety zone{"} by intraoperative cholangiography during laparoscopic cholecystectomy (1996) Surgical Endoscopy, 10 (8), pp. 798-800; Legorreta, A.P., Silber, J.H., Costantino, G.N., Kobylinski, R.W., Zatz, S.L., Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy (1993) Journal of the American Medical Association, 270 (12), pp. 1429-1432. , DOI 10.1001/jama.270.12.1429; Diffenbaugh, W.G., Sarver, F.E., Strohl, E.L., Gangrenous perforation of the gallbladder; Analysis of 19 cases (1949) Arch Surg, 59, pp. 742-749; Isch, J.H., Finneran, J.C., Nahrwold, D.L., Perforation of the gallbladder (1971) Am J Gastroenterol, 55, pp. 451-458; Roslyn, J., Busuttil, R.W., Perforation of the gallbladder: A frequently mismanaged condition (1979) American Journal of Surgery, 137 (3), pp. 307-312; Aronoff, A., Johnson, L.G., Gangrene and perforation of gallbladder during cortisone therapy for rheumatoid arthritis (1958) Can Med Assoc J, 79, pp. 268-271; Bedirli, A., Sakrak, O., Sozuer, E.M., Kerek, M., Guler, I., Factors effecting the complications in the natural history of acute cholecystitis (2001) Hepato-Gastroenterology, 48 (41), pp. 1275-1278; Roslyn, J.J., Thompson Jr., J.E., Darvin, H., DenBesten, L., Risk factors for gallbladder perforation (1987) American Journal of Gastroenterology, 82 (7), pp. 636-640; Wang, A.-J., Wang, T.-E., Lin, C.-C., Lin, S.-C., Shih, S.-C., Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis (2003) World Journal of Gastroenterology, 9 (12), pp. 2821-2823; Johnson, L.B., The importance of early diagnosis of acute acalculus cholecystitis (1987) Surgery Gynecology and Obstetrics, 164 (3), pp. 197-203; Madrazo, B.L., Francis, I., Hricak, H., Sonographic findings in perforation of the gallbladder (1982) American Journal of Roentgenology, 139 (3), pp. 491-496; Ong, C.L., Wong, T.H., Rauff, A., Acute gallbladder perforation-A dilemma in early diagnosis (1991) Gut, 32, pp. 956-958; Bennett, G.L., Balthazar, E.J., Ultrasound and CT evaluation of emergent gallbladder pathology (2003) Radiologic Clinics of North America, 41 (6), pp. 1203-1216. , DOI 10.1016/S0033-8389(03)00097-6; De Vargas MacCiuccam, Lanciotti, S., De Cicco, M.L., Coniglio, M., Gualdi, G.F., Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: Diagnostic protocol assessment based on personal experience and review of the literature (2006) Radiol Med, 111, pp. 167-180; Kim, P.N., Lee, K.S., Kim, I.Y., Bae, W.K., Lee, B.H., Gallbladder perforation: Comparison of US findings with CT (1994) Abdominal Imaging, 19 (3), pp. 239-242; Pedrosa, C.S., Casanova, R., Rodriguez, R., CT findings in subacute perforation of the gallbladder: Report on 5 cases (1981) European Journal of Radiology, 1 (2), pp. 137-142; Felice, P.R., Trowbridge, P.E., Ferrara, J.J., Evolving changes in the pathogenesis and treatment of the perforated gallbladder. A combined hospital study (1985) American Journal of Surgery, 149 (4), pp. 466-473. , DOI 10.1016/S0002-9610(85)80041-6",
year = "2012",
doi = "10.1007/s00464-012-2344-y",
language = "English",
volume = "26",
pages = "3301--3306",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
publisher = "Springer New York LLC",
number = "11",

}

TY - JOUR

T1 - Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases

AU - Lo, Hung-Chieh

AU - Wang, Yu-Chun

AU - Su, Li-Ting

AU - Hsieh, Chi-Hsun

N1 - 被引用次數:4 Export Date: 24 March 2016 通訊地址: Hsieh, C.-H.; Department of Trauma and Emergency Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan; 電子郵件: hsiehchihsun@yahoo.com.tw 參考文獻: Huang, C.C., Lo, H.C., Tzeng, Y.M., Huang, H.H., Chen, J.D., Kao, W.F., Yen, D.H.T., Lee, C.H., Percutaneous transhepatic gallbladder drainage: A better initial therapeutic choice for patients with gall bladder perforation in the emergency department (2007) Emerg Med J, 24, pp. 836-840; Kochar, K., Vallance, K., Mathew, G., Jadhav, V., Intrahepatic perforation of the gall bladder presenting as liver abscess: Case report, review of literature and Niemeier's classification (2008) European Journal of Gastroenterology and Hepatology, 20 (3), pp. 240-244. , DOI 10.1097/MEG.0b013e3282eeb520, PII 0004273720080300000017; Larmi, T.K.I., Kairaluoma, M.I., Junila, J., Perforation of the gallbladder. A retrospective comparative study of cases from 1946-1956 and 1969-1980 (1984) Acta Chirurgica Scandinavica, 150 (7), pp. 557-560; Menakuru, S.R., Kaman, L., Behera, A., Singh, R., Katariya, R.N., Current management of gall bladder perforations (2004) ANZ Journal of Surgery, 74 (10), pp. 843-846. , DOI 10.1111/j.1445-1433.2004.03186.x; Gurusamy, K., Samraj, K., Gluud, C., Wilson, E., Davidson, B.R., Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis (2010) Br J Surg, 97, pp. 141-150; Melloul, E., Denys, A., Demartines, N., Calmes, J.M., Schafer, M., Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: Does it matter? (2011) World J Surg, 35, pp. 826-833; Davis, C.A., Landercasper, J., Gundersen, L.H., Lambert, P.J., Effective use of percutaneous cholecystostomy in high-risk surgical patients: Techniques, tube management, and results (1999) Arch Surg, 134, pp. 727-731. , discussion 731-7222; Melin, M.M., Sarr, M.G., Bender, C.E., Van Heerden, J.A., Percutaneous cholecystostomy: A valuable technique in high-risk patients with presumed acute cholecystitis (1995) Br J Surg, 82, pp. 1274-1277; Derici, H., Kara, C., Bozdag, A.D., Nazli, O., Tansug, T., Akca, E., Diagnosis and treatment of gallbladder perforation (2006) World Journal of Gastroenterology, 12 (48), pp. 7832-7836; Stefanidis, D., Sirinek, K.R., Bingener, J., Gallbladder perforation: Risk factors and outcome (2006) J Surg Res, 131, pp. 204-208; Mocharla, R., Shah, H.R., Gallbladder perforation with contained empyema diagnosed by CT but missed by sonography and hepatobiliary scintigraphy (1997) Am J Roentgenol, 168, pp. 283-284; Fletcher Jr., A.G., Ravdin, I.S., Perforation of the gallbladder (1951) Am J Surg, 81, pp. 178-185; Strasberg, S.M., Hertl, M., Soper, N.J., An analysis of the problem of biliary injury during laparoscopic cholecystectomy (1995) J Am Coll Surg, 180, pp. 101-125; Ido, K., Isoda, N., Kawamoto, C., Suzuki, T., Ioka, T., Nagamine, N., Taniguchi, Y., Kimura, K., Confirmation of a "safety zone" by intraoperative cholangiography during laparoscopic cholecystectomy (1996) Surgical Endoscopy, 10 (8), pp. 798-800; Legorreta, A.P., Silber, J.H., Costantino, G.N., Kobylinski, R.W., Zatz, S.L., Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy (1993) Journal of the American Medical Association, 270 (12), pp. 1429-1432. , DOI 10.1001/jama.270.12.1429; Diffenbaugh, W.G., Sarver, F.E., Strohl, E.L., Gangrenous perforation of the gallbladder; Analysis of 19 cases (1949) Arch Surg, 59, pp. 742-749; Isch, J.H., Finneran, J.C., Nahrwold, D.L., Perforation of the gallbladder (1971) Am J Gastroenterol, 55, pp. 451-458; Roslyn, J., Busuttil, R.W., Perforation of the gallbladder: A frequently mismanaged condition (1979) American Journal of Surgery, 137 (3), pp. 307-312; Aronoff, A., Johnson, L.G., Gangrene and perforation of gallbladder during cortisone therapy for rheumatoid arthritis (1958) Can Med Assoc J, 79, pp. 268-271; Bedirli, A., Sakrak, O., Sozuer, E.M., Kerek, M., Guler, I., Factors effecting the complications in the natural history of acute cholecystitis (2001) Hepato-Gastroenterology, 48 (41), pp. 1275-1278; Roslyn, J.J., Thompson Jr., J.E., Darvin, H., DenBesten, L., Risk factors for gallbladder perforation (1987) American Journal of Gastroenterology, 82 (7), pp. 636-640; Wang, A.-J., Wang, T.-E., Lin, C.-C., Lin, S.-C., Shih, S.-C., Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis (2003) World Journal of Gastroenterology, 9 (12), pp. 2821-2823; Johnson, L.B., The importance of early diagnosis of acute acalculus cholecystitis (1987) Surgery Gynecology and Obstetrics, 164 (3), pp. 197-203; Madrazo, B.L., Francis, I., Hricak, H., Sonographic findings in perforation of the gallbladder (1982) American Journal of Roentgenology, 139 (3), pp. 491-496; Ong, C.L., Wong, T.H., Rauff, A., Acute gallbladder perforation-A dilemma in early diagnosis (1991) Gut, 32, pp. 956-958; Bennett, G.L., Balthazar, E.J., Ultrasound and CT evaluation of emergent gallbladder pathology (2003) Radiologic Clinics of North America, 41 (6), pp. 1203-1216. , DOI 10.1016/S0033-8389(03)00097-6; De Vargas MacCiuccam, Lanciotti, S., De Cicco, M.L., Coniglio, M., Gualdi, G.F., Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: Diagnostic protocol assessment based on personal experience and review of the literature (2006) Radiol Med, 111, pp. 167-180; Kim, P.N., Lee, K.S., Kim, I.Y., Bae, W.K., Lee, B.H., Gallbladder perforation: Comparison of US findings with CT (1994) Abdominal Imaging, 19 (3), pp. 239-242; Pedrosa, C.S., Casanova, R., Rodriguez, R., CT findings in subacute perforation of the gallbladder: Report on 5 cases (1981) European Journal of Radiology, 1 (2), pp. 137-142; Felice, P.R., Trowbridge, P.E., Ferrara, J.J., Evolving changes in the pathogenesis and treatment of the perforated gallbladder. A combined hospital study (1985) American Journal of Surgery, 149 (4), pp. 466-473. , DOI 10.1016/S0002-9610(85)80041-6

PY - 2012

Y1 - 2012

N2 - Background: Gallbladder perforation is a rare but serious complication of cholecystitis. It was usually managed by percutaneous gallbladder drainage (PTGBD) followed by elective cholecystectomy. However, evidences are emerging that early laparoscopic cholecystectomy (LC) is still feasible under these conditions. We hypothesized that early LC may have comparable surgical results as to those of PTGBD + elective LC. Material and methods: From January 2005 to October 2011, patients admitted to China Medical University Hospital with a diagnosis of perforated cholecystitis were retrospectively reviewed. The diagnosis of gallbladder perforation was made by image and/or intraoperative findings. Those patients who had unstable hemodynamics that were not fitted for general anesthesia or those who had concomitant major operations were excluded. Patients were divided into three groups: early open cholecystectomy (group 1), early LC (group 2), and PTGBDfollowed by elective LC (group 3). The demographic features, surgical results, and patient outcome were analyzed and compared between groups. Results: A total of 74 patients were included. All patients had similar demographic features except that patients in group 2 were younger (62 vs. 72 and 73.5 years) compared with group 1 and group 3 (p = 0.016). There were no differences in terms of operative time, blood loss, conversion, and complication rate between three groups. The length of hospital stay (LOS) was significant shorter in group 2 patients compared with that of groups 1 and 3. Conclusions: Although PTGBD followed by elective LC was still the mainstay for the treatment of gallbladder perforation, early LC had comparable surgical outcomes as that of PTGBD + LC but with a significantly shorter LOS. Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD + LC can be preserved for those who carried a high risk of operation. © Springer Science+Business Media, LLC 2012.

AB - Background: Gallbladder perforation is a rare but serious complication of cholecystitis. It was usually managed by percutaneous gallbladder drainage (PTGBD) followed by elective cholecystectomy. However, evidences are emerging that early laparoscopic cholecystectomy (LC) is still feasible under these conditions. We hypothesized that early LC may have comparable surgical results as to those of PTGBD + elective LC. Material and methods: From January 2005 to October 2011, patients admitted to China Medical University Hospital with a diagnosis of perforated cholecystitis were retrospectively reviewed. The diagnosis of gallbladder perforation was made by image and/or intraoperative findings. Those patients who had unstable hemodynamics that were not fitted for general anesthesia or those who had concomitant major operations were excluded. Patients were divided into three groups: early open cholecystectomy (group 1), early LC (group 2), and PTGBDfollowed by elective LC (group 3). The demographic features, surgical results, and patient outcome were analyzed and compared between groups. Results: A total of 74 patients were included. All patients had similar demographic features except that patients in group 2 were younger (62 vs. 72 and 73.5 years) compared with group 1 and group 3 (p = 0.016). There were no differences in terms of operative time, blood loss, conversion, and complication rate between three groups. The length of hospital stay (LOS) was significant shorter in group 2 patients compared with that of groups 1 and 3. Conclusions: Although PTGBD followed by elective LC was still the mainstay for the treatment of gallbladder perforation, early LC had comparable surgical outcomes as that of PTGBD + LC but with a significantly shorter LOS. Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD + LC can be preserved for those who carried a high risk of operation. © Springer Science+Business Media, LLC 2012.

KW - Cholecystectomy

KW - Cholecystitis

KW - Drainage

KW - Laparoscopy

KW - Perforation

KW - adult

KW - aged

KW - cholecystectomy

KW - cholecystitis

KW - clinical effectiveness

KW - controlled study

KW - disease association

KW - early intervention

KW - elective surgery

KW - female

KW - gallbladder perforation

KW - high risk patient

KW - human

KW - intermethod comparison

KW - length of stay

KW - major clinical study

KW - male

KW - operation duration

KW - outcome assessment

KW - percutaneous transhepatic drainage

KW - postoperative hemorrhage

KW - priority journal

KW - retrospective study

KW - review

KW - surgical mortality

KW - surgical risk

KW - Aged

KW - Aged, 80 and over

KW - Cholecystectomy, Laparoscopic

KW - Early Medical Intervention

KW - Female

KW - Gallbladder Diseases

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Rupture, Spontaneous

U2 - 10.1007/s00464-012-2344-y

DO - 10.1007/s00464-012-2344-y

M3 - Article

VL - 26

SP - 3301

EP - 3306

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 11

ER -