EARLY CHOLECYSTECTOMY

IN ACUTE CHOLECYSTITIS: OUR EXPERIENCE

Abstract

Background: This study was conducted to evaluate results of early
cholecystectomy in acute cholecystitis in terms of procedural safety. Methods: In this study 50
consecutive cases of acute cholecystitis who underwent early laparoscopic cholecystectomy
(within 03 days of attack) were included. Patients with symptoms of more than 03 days duration
or those with associated diseases were excluded. Evaluation of results was done by analyzing
the data in SPSS V-17. Results: Out of 50 patients operated 46 (92%) were female and 4 (8%)
were male. Most of the patients were received within 24 hours after the onset of symptoms. The
age of patients ranged from 30-70 years with the median age of 45 years. Ultrasound revealed
oedematous gall bladder with pericholecystic fluid in 38 (76%) patients. In 8 (16%) patients, gall
bladder was small, shrunken and thick walled, there was empyema in 2 (4%) patients &
mucocele with stone impacted at hartmann’s pouch in 2 (4%) patients. Average operation time
was 40 minutes. All patients were operated within 72 hours of onset of symptoms. Per operatively
severe inflammation was noted in 32 (64%) patients, adhesions with colon/stomach/omentum in
10 (20%) patients, adhesions with CBD in 3 (6%) patients, distorted anatomy at Calot’s triangle in
5 (10%) patients. 6 (12%) patients had bleeding from liver bed, but controlled with diathermy. In
46 (92%) patients laparoscopic cholecystectomy was completed successfully. In 4 (8%) patients,
laparoscopic procedure was converted to open cholecystectomy. Reasons of conversion were
acute cholecystitis with severe adhesions which caused bleeding in 2 (4%) patients, obscure
anatomy of Calot's triangle in 2 (4%) patients. Post operatively, there was bile leak in 1 (2%)
patient which was due to minor injury of CBD, which required re-exploration & suturing of defect.
No patient developed post operative jaundice. There was no major bleed post operatively. 3 (6%)
patients developed wound infection. Conclusions: Laparoscopic cholecystectomy is an
effective and safe technique of treating symptomatic gallstones even in cases of acute
cholecystitis because of accelerated recovery couple with less postoperative pain and short
hospital stay.