Role of Laparoscopic Cholecystectomy in the Management of Acute Cholecystitis

Abstract

Objective: To evaluate the outcome of laparoscopic cholecystectomy in the management of acute cholecystitis in term of hospital stay, ease or difficulty of the procedure and to assess the incidence of complications. Design: An observational study. Place and duration of study: The study was conducted at department of surgery ward 2, Jinnah Postgraduate Medical Center Karachi from Jan 2004 to march 2006. Patients and methods : Case records of all patients who underwent laparoscopic cholecystectomy for acute cholecystitis with in the specified period were scrutinized. Patients with the clinical diagnosis of acute cholecystitis were admitted. All patients had ultrasound abdomen, CBC, LFTs and other laboratory work up as required. Fifty patients with diagnosis of acute cholecystitis were included into the study, who fulfilled the inclusion criteria. Patients with acute symptoms more than five days and ASA grade III &IV were excluded .Data on age, gender, ultra sound findings, operative findings, hospital stay and complications were recorded. Results : There were fifty patients 27 males and 23 females. Age ranged from 28 to 73 years, majority belonged to 5 th decade of life. Mean hospital stay was 2.58 days. There was no mortality and CBD injury. Excessive bleeding was encountered in two patients. Hemostasis was secured and blood transfusion was not required. Operative difficulties were experienced in 39 (78%) patients. These were mainly because of presence of adhesions 28 (56%). Difficult dissection in Callot's triangle was experienced due to obscured anatomy in 10 (20%) patients. Perforation of gall bladder occurred in 12 (24%) patients. One case was converted to open cholecystectomy and drain was placed in that case. In postoperative period shoulder tip pain was noticed by 11 (22%) patients and wound infection occurred in 5 (10%) patients. Conclusion: Laproscopic cholecystectomy is reliable and safe modality for the management of acute cholecystitis. Better clinical results, shorter hospital stay and few complications points to significant advantage of laproscopic cholecystectomy in the management of acute cholecystitis.