Abstract
<i>Background</i>: Laparoscopic Cholecystitis (LC) of gangrenous Cholecystitis (GC) which is a serious complication of acute Cholecystitis (AC) is challenging especially in the presence of dense inflammatory adhesions and pericholecystic collection. The aim of this study is to clarify the feasibility and safety of LC in GC. <i>Materials and methods</i>: This is a prospective study done in GIT and LAP surgery unit, General Surgery Department in Tanta university hospital between January 2014 and 2018 on 40 cases of GC from 350 cases of laparoscopymanaged AC. Demographic data, intraoperative time, difficulties of the procedure, postoperative ICU admission, and hospital stay and complications were recorded. <i>Results</i>: GC was suggested preoperatively from old age, DM, CVD, fever > 38°C, tachycardia > 90 beats /minute, leucocytosis> 13,000 /cumm and gallbladder wall thickening>4mm and pericholecystic collection. LC introduces shorter time less difficulties intraoperatively, less need for ICU, shorter hospital stay and less frequent postoperative morbidity. <i>Conclusion</i>: The use of LC in GC is feasible and safe.
Highlights
acute Cholecystitis (AC) is one of the most common reasons for emergency admission in surgical practice
A clinical picture of persistent right hypochondrium and epigastric pain with temperature more than 37.5, tenderness and guarding rigidity of upper abdomen, leukocytic count more 10,000/mm3, in addition to positive Murphy’s sign on ultrasound or the presence of GB wall edema and pericholecystic collection are diagnostic of AC
KHADJIBAEV AB. et al in study of acute gangrenous Cholecystitis (GC), Laparoscopic Cholecystitis (LC) recorded average Intraoperative time 75.0±17.33minutes while in conventional Cholecystectomy it was 85.0±20.00 minutes [20]. In this current study the average Intraoperative time was 78±11 minutes so we find that shorter time is required with LC than open Cholecystectomy
Summary
AC is one of the most common reasons for emergency admission in surgical practice. Cholecystectomy is a gold standard treatment for AC [1].GC is a serious complication of AC [1, 2]. Pre-operative diagnosis of this condition may prove difficult It is more common in men and in patients with coexisting cardiovascular disease (CVD) and leukocytosis (white blood count (WBC) greater than 17 × 103/mm3) [3]. Patients with GC generally undergo emergency Cholecystectomy in order to avoid life-threatening complications [3]. Demographic data, intraoperative time, difficulties of the procedure, postoperative ICU admission, and hospital stay and complications were recorded. Results: GC was suggested preoperatively from old age, DM, CVD, fever > 38°C, tachycardia > 90 beats /minute, leucocytosis> 13,000 /cumm and gallbladder wall thickening>4mm and pericholecystic collection. LC introduces shorter time less difficulties intraoperatively, less need for ICU, shorter hospital stay and less frequent postoperative morbidity. Conclusion: The use of LC in GC is feasible and safe
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