Laparoscopic Cholecystectomy In Acute Cholecystitis – Experience From A Single Centre

Abstract

A total of 140 patients with acute inflammation of the gall bladder were subjected to laparoscopic cholecystectomy. The majority of the patients (62.85%) were in the third and fourth decade of their life with 88 females and 52 males. Pain in the right hypochondrium (RHC), nausea/vomiting, and tenderness of the RHC were present in all patients. Fever (>100F) was noted in 80%, Murphys sign in 71.4%, and a lump in the RHC in14.2% of the cases.All the patients had a total leukocyte count (TLC) of >10,000/cu mm and 11.4% had elevated serum bilirubin, transaminases, and alkaline phosphatase (ALP). Ultrasonography revealed edematous gallbladder (GB) with thickened wall, GB distension, gall stones, and sonographic Murphys sign in all patients. Six (8.57%) cases had mucocele of the GB. A stone impacted at the neck of the GB was seen in 85.7%. The majority of the patients (77.1%) were operated within 48 to 72 hours of admission and the rest before 48 hours. Intra-operative findings included adhesions (100%), distended GB (77.1%), edematous GB wall (97.1%), inflamed GB(100%), and pericholecystic edema (42.8%). Mucocele was present in 8.5% and GB empyema in 68.5% of cases. All patients had gall stones of which 97.1% had them impacted at the neck of GB. Significant bleeding from the liver bed occurred in 34.2% and a short cystic duct was encountered in 5.7%. GB inflammation involved only fundus and body in 71.2%, extending up to the neck in 22.8% and further up to the cystic duct in 5.7%. During surgery, modifications in operative technique included GB decompression in 60%, closed suction drain used in 97.1%, and haemostatic agent used in 24.3%. The procedure was converted to open cholecystectomy in four (2.85%) patients. The mean operative time was 69.2± 8.9 min. Postoperative complications included abdominal pain in 12 (8.57%), fever in 16 (11.4%), basal pneumonitis in 4 (2.85%), biliary fistula in 4 (2.85%) and faecal fistula in 1 (0.71%) of the patients. The mean hospital stay was 5.4±3.7 days.