LAPAROSCOPIC CHOLECYSTECTOMY

TIMING OF LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH MILD ACUTE BILIARY PANCREATITIS

Abstract

Background: Gallstones and biliary sludge accounted for 30–55% of acute
pancreatitis in the West whereas in other countries the incidence of all cases of pancreatitis
amounts up to 68.5%. The risk of subsequent attacks for patients recovering from the first
attack of acute biliary pancreatitis is 30-fold higher than general population. Further attacks
can be prevented by cholecystectomy. Both immediate and delayed cholecystectomies are
used with different degree of success and complication rates. Objectives: To compare the
frequencies of complications in early and late cholecystectomy in cases of mild acute biliary
pancreatitis. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical
unit I Nishtar Medical College/ Hospital Multan. Duration of Study: 2 years from 1-1-2015 to
31-12-3016. Sample Size: Total 172 patients, 86 in each group. Sampling Technique: Nonprobability,
consecutive sampling. Results: In this study there were total 172 cases out of
which 89 (51.74%) were males and 83 (48.26%) females. The mean age was 42.02± 6.36 years
and mean duration of symptoms was 4.08± 2.54 days. Mean duration of surgery was 53.30±
6.30 minutes. There were 47 males in the group undergoing early cholecystectomy and 39 in
delayed with p= 0.44. Both groups had maximum cases in age group of 40-50 year with p=
0.39. There was no significant difference in terms of duration of symptoms (p=0.26) in both
groups. There was significant difference in terms of prolonged duration of surgery where it was
seen in 8 (9.30%) out of 86 cases with early as compared to 2 (2.33%) out of 86 cases with
delayed cholecystectomy with p value of 0.05. Prolonged duration of hospital stay was also
more seen in early cholecystectomy as compared to delayed one, seen in 10 (11.63) cases in
early and 4 (4.65%) cases with delayed surgery in their respective groups with p= 0.09. There
was significant difference (p= 0.008) in terms of per operative complication with early surgery
where it affected the 18 (20.93%) cases as compared to delayed one with 6 (6.95%) cases.
There was again significant difference shown in terms of recurrence of pancreatitis which was
seen in 7 (8.14%) of cases with early as compared to 1 (1.16%) with delayed surgery with
p= 0.03. Conclusion: Early and late cholecystectomies both are performed in tertiary care
hospitals. The late cholecystectomy has shown significantly lower per operative complications,
duration of surgery and chances of the recurrent pancreatitis.