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La colecistectomía laparoscópica es el estándar de oro para el tratamiento de la litiasis vesicular. El presente estudio tiene por objetivo difundir la experiencia de 10 años en colecistectomía laparoscópica del Hospital Municipal Los Pinos de La Paz, Bolivia. Se realizó la revisión de historias clínicas de pacientes internados y sometidos a colecistectomía laparoscópica de junio 2012 a julio 2022, la serie de casos estuvo compuesta por 1095 pacientes; 866 (79.3%) mujeres y 229 (20.7%) varones; el grupo etáreo con mayor casuística fue 31 a 40 años con 256 casos (23.3%), la edad promedio fue de 50,5 (10 a 81 años). La vía de ingreso de los pacientes fue por consulta externa 72.5% y emergencias 27.4%. El tiempo operatorio promedio fue de 85 min. (20 a 150 min.). El diagnostico de ingreso de mayor prevalencia fue la colecistitis crónica litiasica con 766 (69.9%). El factor de conversión a cirugía abierta fue la falta de identificación de estructuras anatómicas, con un índice de conversión de 6.9%. La estancia postoperatoria promedio fue de 3.5 días (1 a 6 días). Basado en los resultados obtenidos la colecistectomía laparoscópica demuestra ser aun el tratamiento seguro y efectivo en pacientes con colelitiasis.
Laparoscopic cholecystectomy is the Gold standard for the treatment of vesicular lithiasis. The present study aims to describe the experience in laparoscopic cholecystectomy of 10 years at Los Pinos Municipal Hospital in La Paz, Bolivia. A review of medical records of hospitalized patients undergoing laparoscopic cholecystectomy from June 2012 to July 2022 was carried out. Case series were 1095 patients; 866 (79.3%) female and 229 (20.7%) male; the age group with higher casuistry was 31 to 40 years (256 cases, 23.3%), the average age was 50.5 (10 to 81 years). The admission of patients was by outpatient 72.5% and emergency unit 27.4%. The average surgery time was 85 min. (20 to 150 min.). The highest prevalence diagnosis at admission was chronic lithiasic cholecystitis (766 cases, 69.9%). The conversion factor to open surgery was the anatomical structures identification difficulty, conversion rate of 6.9 %. The postoperative hospital stay average was 3.5 days (1 to 6 days). Based on the results obtained, laparoscopic cholecystectomy still proves to be the safe and effective treatment in patients with cholelithiasis.
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CholecystectomyABSTRACT
Objective: To evaluate the differences in the presentation, their operative implications and difficulties of single stone versus multiple gall stone disease.Methods: This is a prospective study of a minimum of 60 patients with gall stone disease (Group 1-single, Group 2-multiple) from January 2019 to December 2019 in KGH, Visakhapatnam.Results: More common in females, 40-50 years symptoms and complications, TC count difficult cholecystectomies were more in multiple gall stone pts.Conclusion: Multiple gall stones have led to more severe symptoms and complications and difficult surgery. should be motivated for early surgery even in incidental finding and should not opt for conservative management.
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Background: There is need for conversion in laparoscopic cholecystectomy (LC) in some special situation to open cholecystectomy (OC) in order to minimize intraoperative and post-operative complications. The risk factors may be patient related, the gallbladder’s pathology and the surgeon. Most studies with regards finding the risk factors for conversion in LC involved multiple surgeons which is one of the factors. Our study is prospective study where in all cholecystectomy were done by the single surgeon so as to find out other risk factors for conversion.Methods: This was a prospective study conducted between January 2017 to 2020, where in a total 152 patients posted for LC and 27 got converted to OC. The factors analyzed were the age and sex of the patient, elective or emergency surgery, acute or chronic cholecystitis, comorbid conditions, previous abdominal surgery, post endoscopic retrograde cholangiopancreatography, intra operative adhesions, intraoperative complication like bile duct injury, bleeding from cystic artery or gall bladder bed, bile leak.Results: Out of 152 patient 27 (17.8%) got converted to open cholecystectomy. Mean age was 48.86 with lowest 15 and highest age operated was 83 years, among them 63 (41.4%) were male and 89 (56.8%) were female. Fibrosis at Calot’s triangle, intraoperative adhesions, cirrhosis of liver and age older than 60 years, were all significantly correlated with an increased conversion rate to laparotomy.Conclusions: The risk factors may help to predict the difficulty of the procedure. This would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.
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Cholecystectomy preferably laparoscopy is gold standard treatment for symptomatic cholelithiasis. However for some anatomical and/or pathological reasons the procedure is converted to open. Conversion rates at high volume centres is <5%. We present a case report of 48 aged lady, previously operated multiple times for hydatid liver and lung with symptomatic cholelithiasis. She was planned for laparoscopic cholecystectomy. During the procedure, inadvertent anatomy of “the wandering gallbladder” was noted. Here we describe the management approach selected for this type of unusual presentation. We recommend noting down detailed past history (preferably surgical) and preoperative consideration of deviant anatomical location and findings of gallbladder. We should maintain a low threshold for conversion to open.
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Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and has multiple advantages over open approach. With increasing skills and techniques over the years, the contra-indications to laparoscopic cholecystectomy have reduced. Even after careful selection of appropriate candidates for laparoscopic cholecystectomy, it sometimes becomes necessary to convert into an open cholecystectomy to prevent complications. This study was undertaken so as to identify the intra-operative factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: In this study conducted at S. P. Medical College and P. B. M. Hospital, Bikaner, over a period of 1 year, 100 consecutive patients with symptomatic cholelithiasis, planned for laparoscopic cholecystectomy were included. Laparoscopic cholecystectomy was performed and cases which could not be completed laparoscopically were converted to open cholecystectomy via right subcostal incision. Intra-operative factors necessitating conversion were observed and analyzed.Results: The incidence of conversion was found to be 7%. The most common intra-operative factor for conversion was dense adhesions at the Calot’s triangle (71.43%) followed by obscure anatomy (42.86%). Uncontrolled bleeding and CBD stones also led to conversion. The identification and appearance of CBD and achievement of critical view of safety were significant factors for conversion to open cholecystectomy (p=0.0001).Conclusions: The rate of conversion to open cholecystectomy was 7% which is comparable to similar studies. Conversion is not a failure or complication but actually a safer alternative to ensure completion of the procedure without any real complications of laparoscopic cholecystectomy- biliary or visceral injury, haemorrhage, etc.
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Background: Cholelithiasis is the most common biliary pathology. The definitive treatment for cholelithiasis is either open/ laparoscopic cholecystectomy (LC). The objective of this study was to predict difficulty in doing LC based on clinical and ultrasonographic parameters. Materials and Methods: A hundred patients admitted with a diagnosis of cholelithiasis in surgical wards in the Department of Surgery, Shyam Shah Medical College and Associated Sanjay Gandhi Memorial Hospital, Rewa, from June 1, 2018, to May 31, 2019, were included in the study. All necessary investigations were carried out. X-ray, ultrasonography (USG) abdomen, and blood investigations were done. Patients underwent LC, and a careful record of pre-operative and post-operative findings was made and carefully filled in the pro forma. Results: In the present study, body mass index >27.5 kg/m2 (27%) shows a correlation with predicting difficult LC and conversion to open procedure. Clinical parameters such as guarding and rigidity (8%) with mass (12%) were a sign of acute inflammation, associated with ultrasonography findings favor for difficult cholecystectomy. Gallbladder wall thickness (38%) and pericholecystic fluid collection (16%) in USG are strong predictors of difficulty. Conclusion: Clinical and USG findings help to predict difficulty in laparoscopic cholecystectomy and leading to the conversion of LC to open cholecystectomy.
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Con el objetivo de evaluar la eficacia del sulfato de magnesio como coadyuvante en la analgesia postoperatoria en pacientes sometidos a colecistectomía abierta que ingresaron al Hospital Central Universitario Dr. Antonio María Pineda durante el período mayoagosto de 2018, se realizó un ensayo clínico controlado simple ciego cuya muestra estuvo formada por 50 pacientes asignados aleatoriamente en dos grupos (relación 1:1): grupo experimental quienes recibieron sulfato de magnesio a una dosis de 50 mg/kg vía intravenoso (IV) más ketoprofeno 100 mg IV y grupo control a quienes se les administró solo ketoprofeno 100 mg IV. La intensidad del dolor se estimó a través de la escala visual análoga (EVA). La intensidad basal del dolor fue menor en el grupo experimental. Las dosis analgésicas de rescate requeridas fueron superiores en el grupo control (p ï¼ 0,05) mientras que las náuseas se presentaron sólo en el grupo control. El 62,5% de los pacientes del grupo control con EVA > 4 ameritó medicación de rescate entre 30 minutos a 12 horas post-cirugía y el 37,5% de los pacientes del grupo experimental la requirió entre 8 a 24 horas (p < 0,05). Los resultados evidencian que el sulfato de magnesio es una alternativa efectiva en el tratamiento del dolor postoperatorio.
In order to evaluate the efficacy of magnesium sulphate as a coadjuvant in postoperative analgesia in patients undergoing open cholecystectomy admitted to the Hospital Central Universitario Dr. Antonio Maria Pineda during the May - August 2018 period, we performed a controlled single blind study with a sample of 50 patients randomly assigned to two groups (1:1 ratio): experimental group which received 50 mg/kg intravenous magnesium sulfate plus ketoprofen 100 mg IV and control group which only received ketoprofen 100 mg IV. The intensity of pain was estimated through the visual analogue scale (VAS). Basal pain intensity was less in the experimental group. Analgesic rescue doses were higher in the control group (p ï¼ 0.05) while nausea was only seen in this group. 62.5% of patients of the control group with VAS > 4 required rescue medication between 30 minutes and 12 hours post-surgery while 37.5% of patients of the experimental group received rescue medication between 8 to 24 hours post-surgery (p < 0.05). The results show that magnesium sulphate is an effective alternative in the treatment of postoperative pain.
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Humans , Male , Female , Cholecystectomy , Analgesia , Magnesium Sulfate/administration & dosage , Magnesium Sulfate/therapeutic use , Pain, Postoperative , Perioperative Care , Pain ManagementABSTRACT
Goldman and colleagues identified severe aortic stenosis (AS) as a risk factor for perioperative cardiac complications in non-cardiac surgery. Although patients with aortic stenosis are at an increased risk of perioperative cardiac events, they can undergo non-cardiac surgery relatively safely provided that the condition is recognized and appropriate monitoring and management put in place. The early detection and treatment of hypotension and arrhythmias are essential. We present a case of severe aortic stenosis posted for emergency open cholecystectomy which was successfully managed under epidural anaesthesia and had an uneventful recovery.
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Since the discovery of laparoscopic cholecystectomy, it has become the gold standard treatment for gall bladder pathology, especially cholelithiasis. Various complications can lead to open conversion and in our study we aim to study the various factors that can lead to open conversion. Aims & Objectives: 1. To identify the intra operative findings of difficult laparoscopic cholecystectomy which leads to conversion to open procedure. 2. To contribute experience to the existing data in the literature concerning several important aspect of laparoscopic cholecystectomy. Methods: Patients were recruited as per inclusion and exclusion criterion. The intra-operative findings for those patients undergoing open conversion were documented. Documentation of ultrasonographical (USG) findings i.e., gall bladder wall thickness, contracted / distended gall bladder, stone at the neck of gall bladder, pericholecystic collection etc. Results: In our study, 52 patients required open conversion leading to a conversion rate of 7.5 % which is found comparable with literature on similar studies. Conclusion: Surgeon experience, better patient selection etc. can lead to lower rate of conversion of laparoscopic cholecystectomy to open procedure.
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Introduction: Alpha-2 (α2) adrenergic receptor agonists,clonidine and dexmedetomidine, are widely used as adjuvantsduring anesthesia for analgesic, sedative, sympatholytic, andcardiovascular stabilizing effects. The aim of this study was todifferentiate the effectiveness of intravenously administeredclonidine and dexmedetomidine for hemodynamic stabilityand postoperative analgesia during laparoscopic surgery.Materials and methods: This was a randomised, double blindand prospective study in which Group 1 included patients whoreceived 2 µg/kg of clonidine dilute in 10 ml normal saline,given slow intravenous infusion over 10 minutes beforeinduction of general anaesthesia. Group 2 patients received 1µg/kg of dexmedetomidine diluted in 10 ml of normal saline,given slowly intravenous infusion over 10 minutes beforeinduction of general anaesthesia.Results: The data was presented as Mean ± SD. Groups werecompared by independent student’s t test. Groups were alsocompared by repeated measure analysis of variance (ANOVA)using general linear models (GLM). The mean scores of SBPwere higher in group 1 among both the groups over the periods.The mean scores of DBP in both groups was similar over theperiods with slightly being higher in Group 1 especially after30 min to till end (Extubation) as compared to Group 2.Conclusion: It can be concluded that α 2 agonists were foundto be effective in attenuating the hemodynamic responseto pneumoperitoneum during laparoscopic surgeries andprovides reliable postoperative analgesia and sedation whenused as a premedication agent
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Background: Gallstone disease is a significant health problem world over (in both developing and developed nations). The incidence of gallstone disease increases after age of 40years and it becomes 4-10 times more common in old age. As many as 16% and 29% of women above the age of 40-49 years and 50-59 years, respectively, had gall stones. Laparoscopic cholecystectomy introduced in 1985 has become the procedure of choice for surgical removal of the gallbladder. The aim is to compare laparoscopic cholecystectomy and open cholecystectomy in patients of cholelithiasis by measuring parameters such as use of post-operative analgesia, operative time, post-operative hospital stays, morbidity, mortality and patient satisfaction.Methods: It is a prospective randomized study of 120 patients of cholelithiasis aged between 20years to 80years operated during 2015-2018 at of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. They were divided into open and laparoscopic Cholecystectomy groups by drawing a lottery.Results: The median (range) operation time for laparoscopic cholecystectomy was 55-155 min (mean=102 min) and 40-105 min (mean=72 min) for open cholecystectomy (p <0.001). Form LC group 5 cases had to be converted to OC. Rate of conversion was 5/60=8.3% which is within limits of worldwide laparoscopic cholecystectomy conversion rate of 5% to 10%. LC was found to be superior to OC.Conclusions: Laparoscopic cholecystectomy is better than open cholecystectomy However, open cholecystectomy is preferable in cases of complicated cholecystectomy.
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Background: Open cholecystectomy has been the treatment of choice for more than a century since its introduction and the procedure is standardized among surgeons. Encouraged by the success of laparoscopic cholecystectomy, which has become the gold-standard treatment for gallstone disease in a short span of time, laparoscopic surgery has gained in popularity and found application in almost every surgical specialty. Aim of the study: To compare laparoscopic cholecystectomy and open cholecystectomy with acute cholecystitis. Materials & Methods: The present study was conducted in the Department of General Surgery of Mahatma Gandhi Hospital, Bhilwara, Rajasthan, India. . For the study, we retrospectively viewed the medical records of patients aged 30-65 years with acute cholecystitis who underwent Laparoscopic cholecystectomy (LC) and were compared patients who underwent open cholecystectomy (OC). A total of 44 (22 each for LC and OC) were selected. The analysis of preoperative, intra-operative, and postoperative parameters was done and was compared. Results: A total of 44 patients were included in the study. The surgical procedure for LC and OC were performed by experienced surgeons. The Male/Female ratio in LC and OC group was 14/8 and 12/10 respectively. The mean age of patients in LC group was 42.1+4.8 years and in OC group was 44.5+4.2 years. The mean body weight of LC and OC group was 60.2+9.3 kg and 58.6+8.3 kg respectively. The mean operative time period for LC was 66.8 minutes and for OC was 91.2 minutes. Blood loss more than 500 mL was seen in 2 patients for LC and 4 patients for OC. The nasogastric tube was employed in 8 patients in LC and 12 patients in OC. Conclusion: Laparoscopic cholecystectomy is safer procedure in comparison to open cholecystectomy. The postoperative stay at hospital was shorter with laparoscopic cholecystectomy.
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The article highlights utility of Diffusion Weighted MR Imaging of breast in differentiating benign and malignant lesions along with correlation with histopathological findings. DWI of breast lesions can help predict nature of lesion with reasonable confidence limit.
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Objective To compare the clinical efficacy between laparoscopy and open cholecystectomy for patients of acute calculous cholecystitis. Methods Fifty patients of acute cholecystitis from February 2014 to February 2017 were divided into control group treated with open cholecystectomy and observation group with laparoscopic cholecystectomy;a retrospective analysis was conducted to compare time of resuming peristaltic sound ,postoperative 24h VAS score and hospitalization time. Results There were shorter time of resuming peristaltic sound,higher postoperative 24 h VAS score and shorter hospitalization time in observation group when compared with those in control group (P < 0.05). Conclusions For patients of acute calculous cholecystitis , laparoscopic cholecystectomy,is conducive to shortening patient′s recovery time,alleviating patients′ pain signifi-cantly and decreasing the incidence of complication.
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Objective To investigate the clinical curative effect of laparoscopic cholecystectomy in the treatment of elderly patieuts with acute gaugrenous cholecystitis,and summarized the advantages and disadvantages compared with open cholecystectomy.Methods Using retrospective study,68 elderly patients with acute gangrenous cholecystitis patients in Xiaogan First People's Hospital from January 2010 to January 2015 were selected,and divided into minimally invasive group (36 cases) and laparotomy group (32 cases) according to the different surgical treatment methods,the minimally invasive group patients were treated with laparoscopic cholecystectomy,the laparotomy group patients were treated with open cholecystectomy.Recorded and statistical analysised the incision length,operative time,intraoperative blood loss,laparotomy,postoperative first exhaust time,drainage tube pulled out of time,the degree of pain after operation (visual analogue scale),length of hospital stay,postoperative complications of the two groups.All the patients were followed up by outpatient or telephone,inquiried and recorded the patient's health status up to July 2015.The measurement data were expressed by (x ± s),and the t test was used comparison between groups.The enumeration data was expressed by percentage (％),and the x2 test was used comparison between groups.Results The incision length,intraoperative blood loss,postoperative first exhaust time,length of hospital stay,extubation time were respectively (4.67 ±2.13) cm,(65.67 ±23.61) ml,(31.18 ±4.35) hours,(7.53 ±2.33) days,(2.44±1.31) days in the minimallyinvasive group and (8.48 ±3.49) cm,(103.96 ±35.65) ml,(40.41 ±5.87) hours,(12.34 ±2.94) days,(3.73 ± 1.52) days in the laparotomy group,with statistically significant differences between the 2 groups (all P ＜ 0.05).There was no significant difference in the operation time between the two groups (t =3.574,P ＞ 0.05);The pain scores in the minimally invasive group after 1,3,5 and 7 days were respectively (4.96 ± 1.38) scores,(3.48 ± 1.04) scores,(2.01 ± 0.89) scores,(1.11 ± 0.85) scores and (6.55±1.84) scores,(5.69±1.54) scores,(2.97± 16) scores,(1.81 ±0.94) scores in the laparotomy group,with statistically significant differences between the 2 groups (all P ＜ 0.05).The incidence of complications in minimally invasive group was 17.14％ 6/35),which was significantly lower than that of laparotomy group 41.94％ (13/31) (x2 =15.234,P ＜ 0.05),all the complications were relieved after symptomatic treatment such as anti infection,drainage and so on.All patients were followed up.Among 68 patients enrolled in the study group,1 patient in the minimally invasive group was converted to laparotomy because of excessive adhesion and uncontrollable intraoperative bleeding.The laparotomy group died of septic shock in 1 case,and the remaining patients were treated by surgical treatment.Conclusion Cholecystectomy is effective in treatment of elderly patients with acute gangrenous cholecystitis,and laparoscopic cholecystectomy has the advantages of small incision,less bleeding,less pain,fewer complications and faster recovery after operation thus deserving popularization.
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Objective:To investigate the open method(OC) and laparoscopic cholecystectomy (LC) after bile duct dilation incidence of contrast.Methods:collected from 2006 December to 2014 December in the department of hepatobiliary surgery requires 412 patients underwent cholecystectomypatients hospitalized with cholecystolithiasis,chronic cholecystitis,gallbladderpolyps,were randomly divided into LC group and OC group,LC group of 207 cases,205 cases in OC group,and were respectively treated with LC and OC.Start regular follow-up after a month,the comparison of 2 surgical operation time,blood loss and postoperative application of antibiotics time,anus exhaust time,eating time and hospitalization time.And to observe the two groups the incidence of patients after bile duct dilatation in follow-up after operation.Results:207 cases of LC patients were 89 patients had bile duct dilation,205 cases of OC patients were 41 patients had bile ductdilation,statistically significant differences between the two groups (P＜0.05).In group LC,the diameter of common bile duct in operation half months began to increase,the increase continued until 3 months after operation.After 3 months of little change in the diameter of common bile duct.The averagepreoperative bile duct diameter is 5.3 mm,after 6.1 mm,there was significant difference(P＜0.01).Conclusion:LC is a safe and reliable operation method,Identifying cause dilatation of common bile duct after LC operation and attention as soon as possible to give the corresponding prevention and treatment,further can reduce complications occur.
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Background: Cholecystectomy is the procedure of choice for symptomatic gall stones. Laparoscopic Cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. Several factors have been implicated with a difficult case, but no reliable criteria are available yet to identify patients preoperatively with a difficult LC. Preoperative prediction of a difficult LC can help the patient as well as the surgeon prepare better for the intraoperative risk and the risk of conversion to open cholecystectomy. The present study was undertaken to evaluate role of various factors responsible for conversion from laparoscopic to open cholecystectomy and also to study the intraoperative problems faced by the surgeon responsible for conversion in order to make the procedure safer for the patient as well as the surgeon. Methods: In 50 consecutive patients who underwent LC during 2013 to 2014 patient’s characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were prospectively analyzed to determine predictors of difficult LC. Results: Of 50 patients 3 (06%) required conversion to open cholecystectomy. Significant predictors of conversion were obscured anatomy of Calot’s due to adhesions, sessile gall bladder, male gender and gall bladder wall thickness >3 mm. Conclusions: With preoperative clinical and ultrasonographic parameters, proper patient selection can be made to help predict difficult LC and a likelihood of conversion to open cholecystectomy.
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Objective To compare the effects of different surgical methods for the recovery of elderly patients with acute cholecystitis and provide reference for its clinical treatment. Methods 60 Patients aged 65 years or older undergoing laparoscopic cholecystectomy for acute cholecystitis between January 2010 and December 2013 were selected from the database. The comparison group comprised 76 patients from the same age-group who underwent open cholecystectomy for acute cholecystitis. Then the curative effects of two groups were compared and analyzed. Results 76 patients underwent laparoscopic surgery and 60 had open surgery. The demographic data and co-morbidities were compared between the two groups. The postoperative hospital stay was significantly shorter for patients undergoing laparoscopy (P < 0.05). The overall complication rate was significantly lower for patients undergoing laparoscopy (P < 0.05). There was no statistical significant difference in the operating time and the bleeding among the operation. Conclusions Laparoscopic cholecystectomy is a safe procedure for acute cholecystitis in elderly patients , resulting in fewer complications and shorter hospital stay than open cholecystectomy. Laparoscopic cholecystectomy is worth in the clinical application.
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Laparoscopic cholecystectomy is standard treatment for cholelithiasis. It associates with high incidents of complications when compared to open cholecystectomy. Most common complication is bile duct injuries associate with high morbidity. Normally, proximal ductal injuries are repaired by hepatico-jejunostomy since the incidence of stricture is more common with end-to-end anastomosis. We came across one such case of right hepatic duct injury where the right hepatic duct was completely transected. Immediate end-to-end primary anastomosis was done on a 5F feeding tube. Post-operativecholangiogram (CGM) showed minimal leak at the anastomotic site, displaying the normal proximal ductal system of right lobe. Patient was normal after following for 18 months. It is our opinion that primary anastomosis is preferable particularly when duct is larger in caliber as in our case it was admitting 5F feeding tube. Primary end-to-end anastomosis will reduce the morbidity form leak since chances of leak are more hepatico-jejunostomy and prevent possible ascending cholangitis.
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Background: There is higher incidence of gall stones in Karnataka and more commonly seen in women aged between 25 to 55 years. In this study men are also encountered with gall stone. As all the gall stones cannot be removed by laparoscopic procedure, the complicated and adherent gall bladder with stones and where laparoscopic procedure is not available are removed by conventional open method of cholecystectomy and in this study open cholecystectomy procedure is dealt in detail. Methods: Open cholecystectomy through Right Kocher’s incision. Results: In this study of 10 cases with complications of gall stones dealt surgically by doing open cholecystectomy gave satisfactory postoperative results without much postoperative complications. Conclusions: Among 10 cases of open cholecystectomy 6 cases were done through duct first method and 4 cases were done through fundus 1st method, which gave good results and less postoperative complications.