Gallstone disease remains a major global health issue, and calculous cholecystitis represents its most frequent clinical expression. In acute-on-chronic cases, chronic fibrotic changes obscure Calot’s triangle and distort biliary anatomy, increasing the difficulty of laparoscopic dissection. Although laparoscopy is standard, these patients exhibit elevated conversion rates and postoperative morbidity.

This study evaluates complications arising from surgery for acute-on-chronic calculous cholecystitis in a consecutive series of 65 patients managed at a tertiary centre.

MATERIALS AND METHODS

Study Design and Setting: Retrospective case-series, Department of General Surgery, RajaRajeswari Medical College and Hospital, Bengaluru. Institutional approval was obtained.

Inclusion Criteria: Adults diagnosed with acute-on-chronic calculous cholecystitis (clinical, radiologic, and histopathologic confirmation).

Exclusion Criteria: Acalculous cholecystitis, gallbladder carcinoma, or inadequate 30-day follow-up.

Data and Analysis: Demographics, operative details, complications, and outcomes were collected. Complications were defined per international standards. Descriptive statistics were calculated using SPSS v26.

RESULTS

Demographics: 65 patients; mean age 46.2 years (25–70); 48 female, 17 male.

Operative approach: 59 laparoscopic (90.7 %); 11 converted to open (16.9 %) for dense adhesions or unclear anatomy; 6 primary open (9.2 %).

Intraoperative complications:
– Gallbladder perforation with bile spillage 14 (21.5 %)
– Bleeding at Calot’s triangle 5 (7.7 %)
– Bile-duct injury 2 (3.1 %)

Postoperative complications:
– Surgical-site infection 9 (13.8 %)
– Bile leak 4 (6.2 %)
– Residual CBD stones 3 (4.6 %)
– Subhepatic abscess 1 (1.5 %)

Mean hospital stay 5.8 ± 2.6 days; no mortality.

DISCUSSION

Operative difficulty and complication risk in acute-on-chronic calculous cholecystitis arise primarily from fibrosis and distorted anatomy. Our conversion rate (16.9 %) matches published data and reflects prudent surgical judgment rather than procedural failure.

Bile-duct injury (3.1 %) was managed intraoperatively with appropriate reconstruction. Frequent gallbladder perforation underscores the friability of chronically inflamed tissue; prompt lavage and retrieval of spilled stones prevent later abscesses.

Postoperative bile leaks were controlled conservatively or endoscopically. These findings align with international recommendations emphasizing early drainage, ERCP, and selective re-exploration.

CONCLUSION

Acute-on-chronic calculous cholecystitis presents elevated surgical risk due to fibrotic distortion. Diligent operative strategy, situational awareness, and timely conversion can minimize morbidity. Early postoperative surveillance for bile leak or infection is essential for optimal recovery.

Acknowledgements

We thank the surgical and nursing staff of RajaRajeswari Medical College and Hospital for their assistance in data collection and patient management.

Conflicts of Interest

None declared.

Funding

No external funding.

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