Clinical effects of laparoscopy and laparotomy in treatment of gangrenous cholecystitis

Objective To compare the clinical effects of laparoscopic cholecystectomy( LC) and open cholecystectomy( OC) in the treatment of gangrenous cholecystitis and their influence on inflammatory mediators. Methods A total of 82 patients with gangrenous cholecystitis who underwent surgery in 22 Hospital of PLA from January 2012 to June 2015 were enrolled and divided into LC group( 42 patients) and OC group( 40 patients). The condition of surgery and perioperative levels of inflammatory mediators were compared between the two groups.The t- test was used for comparison between the two groups,and the chi- square test was used for categorical data. Results All the patients underwent the surgery successfully without deaths during the perioperative period,and three patients were converted to laparotomy.The rate of partial cholecystectomy,time of operation,intraoperative blood loss,and hospital costs showed no significant differences between the two groups( all P > 0. 05). The LC group had a shorter length of postoperative hospital stay,a lower rate of drainage tube placement,and fewer postoperative complications compared with the OC group,but only the length of postoperative hospital stay showed a significant difference between the two groups( t = 7. 472,P < 0. 001). The LC group experienced significant reductions in the serum white blood cell count( WBC),C- reactive protein( CRP),interleukin- 6( IL- 6),and tumor necrosis factor α( TNFα) on days 3 and 5 after surgery( all P < 0. 05). The OC group experienced significant increases in serum WBC,CRP,IL- 6,and TNFα on day 1 after surgery,and significant reductions in these indices on days 3 and 5 after surgery( all P < 0. 05). The LC group had significantly lower serum WBC,CRP,IL- 6,and TNFα on days 1,3,and 5 after surgery compared with the OC group( all P < 0. 05). Conclusion LC is safe and effective in the treatment of gangrenous cholecystitis. Compared with OC,LC has the advantages of less trauma and faster recovery after surgery and can reduce the release of inflammatory mediators.