ABSTRACT
OBJECTIVE: The present study is designed to compare early and interval laparoscopic/open cholecystectomy in patients of acute cholecystitis. The comparison was done on the basis of parameters such as intraoperative difficulty, perioperative bile duct injury and bile leak, time taken for operation, postoperative atelectasis, postoperative wound infection, duration of hospital stay and postoperative pain. METHODOLOGY: This is a prospective study conducted in Department of General surgery, GCS MEDICAL COLLEGE, HOSPITAL AND RESEARCH CENTRE from AUGUST 2018 to DECEMBER 2019. 56 patients were enrolled in the study from which 26 patients were randomly assigned to early lap/open cholecystectomy and 30 were assigned to interval lap/open cholecystectomy group. RESULT: There was no significant difference observed between the two groups. However, the duration of hospital stay was less in early laparoscopic/open cholecystectomy. CONCLUSION: Both the methods, early and interval have no significant benefit over each other but through review of all literature, early lap/open cholecystectomy is found to be beneficial overall with less hospital stay.
ABSTRACT
Several randomized studies in the early 1980s have shown that performing early cholecystectomy for acute cholecystitis was better than delayed cholecystectomy in terms of operative feasibility, post-operative complications and shorter hospital stay. In the era of minimal access surgery, laparoscopic cholecystectomy is widely established as the standard in acute cholecystitis. However, in the presence of acute inflammation, higher conversion rates of up to 30 % have been reported. Several studies have reported favourable outcomes with a low conversion rate if patients are operated within 96 hours of admission. In this study we compare the safety, intra-operative difficulty, post-operative morbidity, duration of stay in hospital, and effectiveness of early lap- / open-, versus delayed (late) lap- / open- cholecystectomy in acute cholecystitis. MethodsThis is a prospective study conducted in the Department of General Surgery, Government Stanley Medical College, from October 2016 to August 2017. From cases attending our institute for treatment of acute cholecystitis, 25 patients with acute cholecystitis were subjected to early lap- /open- cholecystectomy within 7 days of onset of symptoms and another 25 patients were subjected to late cholecystectomy at least 6 weeks after symptoms have subsided. ResultsThe two groups were well matched in terms of age, sex as well as clinical and laboratory parameters. Both early and late groups were compared both in terms of intraoperative and post-operative complications. Among the early group, 17 [68%] underwent laparoscopic cholecystectomy and 8 [32%] underwent open cholecystectomy. In the late group 19 [76%] underwent laparoscopic cholecystectomy and 6 [24%] underwent open cholecystectomy. Taking bile duct injury in to account 3 patients [12%] among the early group and 6 patients in DC [24%] had bile duct injury. 4 patients [16 %] in the early group and 6 patients [24%] in the late group had wound infections. In the early group, 6 patients [24%] and 10 patients [40%] in the late group had lung infections. Duration of stay in early cholecystectomy group was shorter when compared to patients who underwent late cholecystectomy. ConclusionsEarly cholecystectomy is safe in terms of dissection of Calot’s triangle and bile duct injury. The duration of surgery, the rate of wound infection, and the hospital stay, are however significantly shorter than the delayed cholecystectomy and reduces the rate of medical treatment failure and biliary peritonitis.
ABSTRACT
Background: For patients with acute cholecystitis the timing of operative intervention has two broad approaches- early cholecystectomy and elective or delayed cholecystectomy. The main advantage of early cholecystectomy is that, it offers a definitive treatment during the same admission and avoids the problem of failed conservative treatment. The present study is an endeavour to discuss and to compare the outcome of management of acute cholecystitis with early and delayed cholecystectomy.Methods: 100 patients with clinical diagnosis of acute cholecystitis, admitted in the surgical wards of Gauhati Medical College and Hospital during the period of 1st July 2017 to 30th June 2018 were selected for the study. 40 patients underwent early cholecystectomy (within 7 days of onset of symptoms) and 60 patients underwent elective or late cholecystectomy (after a gap of 6-8 weeks from the acute attack).Results: In the present series the average duration of surgery was 90.37±11.96 minutes in the early group and 65.3±7.83 minutes for the elective group which is found to be statistically significant (p value<0.05). In the early surgery group 8.33% required conversion to open surgery. In the elective surgery group 3.63% required conversion. Wound infection, biliary leakage, bile duct injury, and respiratory tract infection was found to be statistically not significant between the two groups.Conclusions: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system.
ABSTRACT
Background: Acute biliary pancreatitis (ABP) is one of the most serious complications of gall stone disease with a high risk of morbidity and mortality. Hence accurate diagnosis and prompt management of ABP is very crucial. Different management strategies exist regarding indications and timing for interventions, endoscopic retrograde cholangio-pancreaticography (ERCP) and cholecystectomy.Methods: Ours is a prospective observational study of the different clinical presentations and management strategies and their respective outcomes in our hospital. All cases of ABP admitted over a period of one year were included in the study. The clinical presentation, severity and course of the disease, imaging studies, duration of ICU and hospital stay and timing of ERCP and cholecystectomy were studied.Results: A total of 56 cases were included in the study. Average age was 45 years. Pain abdomen was the most common symptom at presentation. About 82% patients had mild to moderate disease while the rest had severe disease. The mean duration of intensive care unit stay was 8 days. ERCP was done in 6 cases. Cholecystectomy during the same admission was dine in 20 cases. There were 2 deaths during the course of the study.Conclusions: Early intervention definitely reduces morbidity, mortality and recurrent admissions in cases of acute biliary pancreatitis. Same admission laparoscopic cholecystectomy is preferable in mild ABP. All cases of severe ABP must undergo early ERCP irrespective of biliary obstruction. This also helps in reducing readmissions due to pancreatic-biliary complications and is cost-effective.
ABSTRACT
Background: In the whole world including India, the incidence of acute cholecystitis is increasing day by day. Gall stones are the most common cause of acute cholecystitis in 90-95% of the cases. The management of acute cholecystitis was conservative earlier but now there are studies recommending early surgery as the treatment of choice.Methods: Our study was conducted on 60 patients divided into two groups of 30 each to compare the results of early surgery with the delayed surgery.Results: The overall post-operative complication rate was same in both the groups but there was significant difference in the total hospital stay and total cost of the therapy in both the groups. The average total hospital stay in early group was 6.50±4.44 days and in delayed group was 10.80±5.55 days without including the number of days in non-operating admission.Conclusions: So, early cholecystectomy was found to be more economical with less total hospital stay and less total cost of the therapy than interval cholecystectomy in acute cholecystitis.