Outcome of Same Admission Laparoscopic Cholecystectomy for Acute Cholecystitis in A District Hospital

摘要

Abstract | Back ground. The treatment of acute cholecystitis has been extensively discussed in the literature. It has evolved through various stages of conservative management to surgical management from open to laparoscopic cholecystectomy and from delayed to early laparoscopic cholecystectomy. Objective: To measure the outcome of same admission laparoscopic cholecystectomy for acute cholecystitis in terms its feasibility and safety in a district hospital. Methods: Total 300 patients (male & female) of acute cholecystitis excluding those patients with choledocholithiasis, upper abdominal surgery, and cardiopulmonary disease were underwent same hospital admission laparoscopic cholecystectomy in District Hospital Gujranwala from August 2015 to August 2018. Four ports technique for Laparoscopic cholecystectomy was used. The collected data included age, sex, diagnosis, and operative time, conversion to open cholecystectomy, operative complications and postoperative stay. Result: laparoscopic cholecystectomy was performed in 300 patients. P value 0.05 was considered statistically significant and appropriate statistical tests of significance were applied. out of these 285(95%) and 15 (5%) patients were converted to open cholecystectomy because of troublesome dissection in Callot's triangle, perforated gall bladder, bile duct injury and difficult to control bleeding in operative area. Mean laparoscopic surgery time was 1.4 hours. There were minor wound infection in all converted cases but none in cases of laparoscopic cases with postoperative stay in the range of 1-3 days. There was no mortality in this study. Conclusion: Same admission laparoscopic cholecystectomy was found safe and feasible in acute cholecystitis in peripheral district hospital by surgeons who have reasonable previous experience of elective laparoscopic cholecystectomy and should be their first choice for acute cholecystitis.