OPEN VERSUS LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS; AN INSTITUTIONAL EXPERIENCE
Objectives: Toevaluate the outcome of laparoscopic cholecystectomy as compared with open cholecystectomy in compensated cirrhotic patients. Study Design: Prospective randomized study. Setting: Department of Surgery, Liaquat University Hospital, Jamshoro. Liaquat University Hospital is Tertiary Care Hospital in the region of Hyderabad and Jamshoro. Period: Three years from January 2011 to December 2014. Patients and Method: Total 172 patients presentedwithsymptomatic gall stone disease and compensated cirrhosis were randomly divided in to two groups, open cholecystectomy group and laparoscopic cholecystectomy group. Study variables were age, sex, cause of cirrhosis, surgical time, blood loss during and after surgery, hospital stay and postoperative complications. After inform consent, data was collected on preformed proforma. For statically analysis SPSS 16 were used, statically significance were defined a P value < 0.05. Results: In patients for open cholecystectomy group cirrhosis was developed due to secondary infection hepatitis C in 56 (65.88%), hepatitis B in 21 (24.70%) and hepatitis B & C in 08 (9.42%). In laparoscopic cholecystectomy group patients cirrhosis was developed due secondary infection with hepatitis C in 62 (71.26%), hepatitis B in 15 (17.24%) and hepatitis B & C in 10 (11.5%). Laparoscopic cholecystectomy was done on 79 (90.80%) and eight (9.20%) patients converted in to open cholecystectomy due to difficult dissection in three patients and bleeding developed into five patients. The time of surgery was shorter in laparoscopic cholecystectomy group (60.15±15 min) as compared to 75.10±15 minutes in open cholecystectomy group. Oral diet was started early (08-18H) after laparoscopic cholecystectomy as compared to open cholecystectomy (24-12) hours. Hospital stay was also shorter in laparoscopic cholecystectomy group (1.5±1) days versus 03±01 day in open cholecystectomy group. Conclusion: Laparoscopic cholecystectomy is safe, more feasible, needless operative time and less postoperative complicationsin compensated cirrhotic patient as compare to open cholecystectomy but laparoscopic cholecystectomy needs more expertise and availability of instruments.