الفهرس 
Anatomy and Embryology of Gall Bladder and Biliary TractOnly 14 pages are availabe for public view
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Abstract
Acute cholecystitis is inflammation of the gallbladder, which is the most common complication of gallstones, which requires hospitalization and immediate intervention. Its symptoms include pain in the upper right part of the abdomen, nausea, vomiting, and sometimes fever. Often attacks of the gallbladder (biliary colic) precede acute cholecystitis; without proper treatment, common recurrent bouts of cholecystitis occur. Complications include acute cholecystitis (pancreatitis gallstones, common bile duct stones, and common bile duct inflammation).
More than 90% of acute cholecystitis cases are caused by the blockage of the cystic duct by stones. Diagnosis of cholecystitis based on symptoms and laboratory tests. An abdominal ultrasound is usually used to confirm the diagnosis.
The high recurrence of gallstones complications after initial hospitalization requires surgical removal of the gallbladder, either early or late
However, the medical history of patients who are unable to undergo a cholecystectomy at the beginning of their medical examination presents a unique set of challenges such as the delay in attending the medical examination, as well as the diseases accompanying them and thus increase the complications and morbidity related to the presence of stones.
Treatment options include: surgery early in the patient’s admission to the hospital, either by laparoscopic cholecystectomy or open cholecystectomy, or by delaying cholecystectomy (surgery after successful conservative treatment), or antibiotic therapy or percutaneous treatment for these patients, in which surgery is the proportion. They have a high risk.
In fact, there is ample data motivating early surgery rather than delayed cholecystectomy. It was noted that the length of stay in the hospital was reduced when the surgery was performed early and the situation did not differ in the rate of complications. Moreover, many patients who underwent late surgical intervention through randomized trials had persistent or recurring symptoms that required early intervention before the intervention. Planned late surgical procedure.
By comparing laparoscopic surgery to open surgery, laparoscopic cholecystectomy has become the preferred approach for cholecystectomy in non-emergency cases, however half of the cases still undergo open surgery.
Some authors consider the presence of inflammation, infiltration, and cellular erosion as unfavorable conditions for surgery. As a result, laparoscopic surgical intervention is delayed after recovery from acute infections. In 2013 a new edition of the Tokyo Directive was issued with the aim of determining the best surgical treatment for acute cholecystitis according to the severity of the disease, its timing, and the procedures needed. Acute cholecystitis is classified as mild, moderate and severe on the basis of the degree of cholecystitis rather than the different patient conditions, which results in different treatment options for the three grades of acute cholecystitis.
The 2013 Tokyo Directive raised concerns in some respects about higher morbidity rates when performing laparoscopic surgery in emergency situations and is diverting to open surgical intervention.
Aim of the Work:
To assess surgical outcome from laparscopic and open cholecystectomy in acute calcular cholecystitis by assessment and differentiate between both of them in these parameters as regards:
1-Hospital stay
2-Wound infection
3-Bilary fistula
4-Missed stone
5-intestinal injury