Strategy and outcome of cholecystectomy on severe acute cholecystitis

[Backgrounds and Aims]Severe acute cholecystitis is defined as acute cholecystitis impacts on systemic condition in TG18. The aim is to introduce our surgical strategies and outcome of surgery on acute cholecystitis.[Methods]Patients undergone cholecystectomy for acute cholecystitis during January 2017 to December 2021 were included in this study. [Results]We standardize surgical steps using educational video. After exposing SS inner layer on dorsal side of gallbladder and tunneling behind gallbladder neck, showing CVS is the first step. If tunneling can’t be done, fundus first approach is chosen after separating on gallbladder neck to maximum extent as a landmark. With the landmark, we can keep away from gallbladder plate and hilar plate. If separation can’t go toward cystic duct, gallbladder wall is divided and subtotal cholecystectomy is chosen.Of 597 patients, 90 patients (15.1%) were sever cases (S group). Average surgical time was 118 minutes in mild and moderate cases (M group) and 156 minutes in S group (p=0.002), blood loss was M group:25.1g, S group:370.8g (p＜0.001) and postoperative hospital stay was M group:8.7 days, S group:19.4 days (p＜0.001). Bailout surgery was performed on 14 cases (2.7%) in M group and 23 cases (25.6%) in S group (p＜0.001). Conversion to laparotomy was 5 cases (1.0%) in M group and 5 cases (6.0%) in S group (p=0.007). No case was injured on bile duct, and mortality rate was 0.2%.[Conclusion]Short term outcome of S group were worse than M group. However, bile duct injury can be prevented with standardized surgical steps.