ABSTRACT
Objective: To assess the role of laparoscopic cholecystectomy [LC] in gallstone disease with its complicated problems. Design: Prospective observational study. Setting: Surgical Department of Liaquat University of Medical and Health Sciences, Jamshoro and Private Hospitals of Hyderabad, Sindh-Pakistan; from May 2001 to April 2005
Methods: The patients were categorized as cases of complicated gallstone disease on the basis of clinical assessment, investigations especially ultrasound abdomen and operative findings noted during laparoscopic cholecystectomy. All patients were explained for advantages and disadvantages of early LC with their difficult disease problem and willing taken for study. Sampling strategy was convenient. The patients with uncomplicated gallstones, obstructive jaundice, acute pancreatitis and carcinoma of gall bladder were excluded from this series
Results: 120 out of 400 patients presented with one of the known complication of cholelithiasis such as chronic cholecystitis 50%, acute cholecystitis 12.5%, empyma 18.33%, mucocele 10% and fibrosed gall bladder in 9.17% of cases as assessed on clinical examination, ultrasound and laparoscopic findings. Majority [75%] of cases were having adhesions around gall bladder and 25% without adhesions. Problems encountered during LC were difficult separation of tight adhesions around gallbladder [50.0%], grasping and holding of thick walled and distended gallbladder [41.67%], dissection and identification of structures in Calot's triangle [29.17%], haemorrhage from main cystic artery and gall bladder bed 20.83% and delivery of large and thick wall gallbladder in 25% of cases. Intra operative complications seen during procedure were haemorrhage in 20.83% cases, perforation of gallbladder by instrumentation in 12.5% and avulsion of cyctic duct in 1.67% of cases. Two patients [1.67%] were converted to open cholecystectomy due to bleeding. Postoperatively 12.5% of patients developed biliary leak, out of which 3 cases [2.5%] were due to actual common bile duct injury, 2.5% of cases developed port-site sepsis as main postoperative complications. Cases with bile duct injury were re-explored and managed accordingly. Hospital stay varied from 2-7 days but majority of patients were discharged [70.83%], within 2-3 days, no mortality was seen in this series
Conclusion: Laparoscopic cholecystectomy like uncomplicated biliary stone disease is equally effective procedure for complicated cholelithiasis. Its applicability is almost 95% in experienced hands