EARLY CHOLECYSTECTOMY

Abstract

Background: This study was conducted to evaluate results of earlycholecystectomy in acute cholecystitis in terms of procedural safety. Methods: In this study 50consecutive cases of acute cholecystitis who underwent early laparoscopic cholecystectomy(within 03 days of attack) were included. Patients with symptoms of more than 03 days durationor those with associated diseases were excluded. Evaluation of results was done by analyzingthe data in SPSS V-17. Results: Out of 50 patients operated 46 (92%) were female and 4 (8%)were male. Most of the patients were received within 24 hours after the onset of symptoms. Theage of patients ranged from 30-70 years with the median age of 45 years. Ultrasound revealedoedematous gall bladder with pericholecystic fluid in 38 (76%) patients. In 8 (16%) patients, gallbladder was small, shrunken and thick walled, there was empyema in 2 (4%) patients &mucocele with stone impacted at hartmann’s pouch in 2 (4%) patients. Average operation timewas 40 minutes. All patients were operated within 72 hours of onset of symptoms. Per operativelysevere inflammation was noted in 32 (64%) patients, adhesions with colon/stomach/omentum in10 (20%) patients, adhesions with CBD in 3 (6%) patients, distorted anatomy at Calot’s triangle in5 (10%) patients. 6 (12%) patients had bleeding from liver bed, but controlled with diathermy. In46 (92%) patients laparoscopic cholecystectomy was completed successfully. In 4 (8%) patients,laparoscopic procedure was converted to open cholecystectomy. Reasons of conversion wereacute cholecystitis with severe adhesions which caused bleeding in 2 (4%) patients, obscureanatomy of Calot's triangle in 2 (4%) patients. Post operatively, there was bile leak in 1 (2%)patient which was due to minor injury of CBD, which required re-exploration & suturing of defect.No patient developed post operative jaundice. There was no major bleed post operatively. 3 (6%)patients developed wound infection. Conclusions: Laparoscopic cholecystectomy is aneffective and safe technique of treating symptomatic gallstones even in cases of acutecholecystitis because of accelerated recovery couple with less postoperative pain and shorthospital stay.