Abstract
Background: Although acute cholecystitis is one of the most common indications for abdominal
surgery in patients with acquired immunodeficiency syndrome (AIDS), previous studies
have reported disappointingly high morbidity and mortality among those patients who
have undergone cholecystectomy. The aims of this study were to analyze the indications
for and the outcome of cholecystectomy performed for acute cholecystitis in patients
with AIDS. Methods: We retrospectively reviewed the hospital charts of 53 patients with AIDS who underwent
open or laparoscopic cholecystectomy from 1992 to 1997. Statistical analysis using
the chi-square, Student's t, and Fisher exact tests was conducted to determine whether
cause of cholecystitis, type of surgical approach, and CD4+ T-lymphocyte count influenced
outcome. Results: The clinical findings and imaging by ultrasonography were always reliable in establishing
diagnosis and guiding treatment of acute cholecystitis. Open cholecystectomy was performed
in 24 patients (45%). The procedure was begun laparoscopically in 29 patients (55%)
and converted to open in 4 (14%). The pathologic findings showed acalculous cholecystitis
in 19 patients (36%) and cholelithiasis in 32 (60%). Morbidity was 34% and mortality
was 2%. Type of operative approach, cause of cholecystitis, and CD4+ T-lymphocyte
count (greater or less than 50 cells/mm3) did not significantly affect morbidity and mortality. The length of hospital stay
was significantly influenced by the CD4+ T-lymphocyte count. Conclusions: These findings suggest that in most patients with AIDS, laparoscopic or open cholecystectomy
may be performed with significant but acceptable morbidity and low mortality. (Surgery
1999;125:172-7.)
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Article info
Publication history
Accepted:
August 18,
1998
Footnotes
☆Reprint requests: Marco Ricci, MD, PhD, Department of Surgery, Cabrini Medical Center, 227 E 19th St, Suite D-309, New York, NY 10003.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
