Trends in surgical management of acute cholecystitis: 10 years experience from a tertiary care hospital of developing country

Abstract

Introduction: Treatment for acute cholecystitis includes cholecystectomy and in high risk patients, initial medical management, followed by cholecystectomy. Our aim was to look for trends in surgical management of acute cholecystitis at Aga Khan University Hospital over a period of 10 years. Methods: A retrospective study was performed by reviewing the medical records of patients who underwent cholecystectomy after a preoperative diagnosis of acute cholecystitis admitted to our hospital, from January 2001 to December 2010. Patients were divided into Group-I (2001–2005) and Group-II (2006–2010). Results: A total of 567 patients met inclusion criteria. Mean age was 50.4 years and 46% were male. Nearly 74% of patients had laparoscopic cholecystectomy. Conversion rate from laparoscopic to open cholecystectomy was 19.2%. Early cholecystectomy was performed in 72% of patients. Percutaneous cholecystostomy tube was used in 8.6% of patients. A total of 6.5% patients developed complication. Most common morbidity was wound infection (3.9%), followed by intra-abdominal abscess (1.6%). Bile duct injury was reported in 0.7% cases. Almost 60% of patients were discharged within 48 hours. On comparing Group-I (n = 170) and Group-II (n = 397), significant increase in early cholecystectomy (79.5% vs. 54%, p = 0.00) and decrease in conversion rates (15.9% vs. 27%, p = 0.02) were noticed in Group-II. Conclusion: This is the largest series from Pakistan in this regard. Over the years our experience of managing acute cholecystitis has changed dramatically. Now early laparoscopic cholecystectomy is being performed more frequently, with comparable morbidity rate, also frequency of conversion has fallen significantly in all grades of acute cholecystitis.