Laparoscopic cholecystectomy for empyema gall bladder

Objective: To describe the experience of treating empyema gall bladder with laparoscopic cholecystectomy. Study Design: Descriptive observational study

Place and Duration of Study: The study was carried out at Combined Military Hospital [CMH] Peshawar, from Feb 2012 till May 2014 for a period of twenty eight months

Material and Methods: Twenty eight patients were enrolled in the study who fulfilled the criteria for empyema and were willing for laparoscopic cholecystectomy, chances of conversion to open cholecystectomy and risk of complications involved. We defined the operative difficulty levels according to the intra-operative findings. Level 1-adherent ornentum, level 2-oedematous gall bladder wall, level 3-necrotic gall bladder wall, level 4-adherent gut and level 5 - adherent Hartmann's pouch and oedematous Calot's triangle having no defined planes. The results were noted in terms of time taken for the operation and complications of the operative procedure. Results: Twenty eight patients of empyema gall bladder underwent laparoscopic cholecystectomy. Mean age was 46.2 +/- 7.1 years. Average duration of symptoms was 4.1 +/-2.3 days. Two patients had level-I operative difficulty, 6 patients had level-II difficulty, 9 patients had level-3 difficulty, 2 patients had level-IV difficulty and 9 patients had level-V difficulty. In 21[75%] patients total cholecystectomy was performed, anterior partial cholecystectomy was done in 2 patients [7.1%] and 5 patients [17.9%] were converted to open cholecystectomy. One patient [3.5%] had Stresburgh Bismuth type D injury and was managed by open exploration and T-tube placement. No mortality was encountered in the study group

Conclusion: The technique of laparoscopic cholecystectomy can be used effectively for treating empyema gall bladder specifically in American Society of Anaesthesiologists [ASA] I and II patients. Further randomized controlled trials can elaborate its efficacy. This will not only prove to be cost effective but it will also add to the comfort of the patient

experience with early laparoscopic cholecystectomy in acutely inflamed gall bladder: a review of 116 cases

Objective: To see the outcome of early laparoscopic Cholecystectomy in acutely inflamed gall bladder

Study Design: A prospective interventional study

Place and Duration: Surgery unit-I of Fauji Foundation Hospital, Rawalpindi from 1[st]January 2005 to 30[th] June 2009

Methodology: Patients admitted with acutely inflamed gall bladder within 72 hrs of symptoms were subjected to early laparoscopic Cholecystectomy. All operative findings, per-operative and post operative complications and follow up details were recorded meticulously on a Performa and analyzed

Results: Laparoscopic Cholecystectomy on acutely inflamed gallbladder was performed in 116 patients. Among them 70.68% patients had acute cholecystitis, 22.43% empyema gall bladder and 6.89% gangrenous gall bladder. The overall conversion to open cholecystectomy was 11.20% and it was highest [14.28%] in gangrenous GB, followed by empyema GB [7.69%]. Pus or infected fluid collection found in 6.89% patients and 1.72% had visceral injury during surgery. No mortality was observed

Conclusion: Early laparoscopic Cholecystectomy in acute gall bladder is safe and feasible option and should be considered in patients instead of interval Cholecystectomy