RESUMO
Although laparoscopic cholecystectomy is well accepted as the golden standard for the management of symptomatic choleslithiasis yet acute cholecystitis is still challenging the technique. To study the role of laparoscopic cholecystectomy for the management of early acute cholecystitis [within seven days of onset]. Patients: Two groups [twenty patients each]. Group I included patients with acute calcular cholecystitis who underwent laparoscopic cholecystectomy within seven days of onset. Group II included patients with chronic calcular cholecystitis for whom laparoscopic cholecystectomy was done. Plan: All patients of both groups had proper clinical assessment, routine laboratory investigations, liver chemistry profile and abdominal ultrasound. The classical four-trocar method of laparoscopic cholecystectomy was employed in all patients and modifications required for group I of patients were noted. The operative data, the postoperative course and recovery as well as the postoperative morbidity were analyzed in both groups. All patients were followed for at least six months postoperatively. The diagnosis of acute calcular cholecystitis based on clinical, laboratory and ultrasound findings together with operative assessment. Right upper quadrant abdominal pain, fever, leucocytosis and ultrasound findings [ultrasound guided Murphy's sign, thickened gall bladder wall, gall bladder distension and increased size, presence of gall stones and presence of pericholecystic fluid] were the commonest and most importtant features of acute cholecystitis. Laparoscopic cholecystectomy could be performed successfully in all patients of group II and in [18] patients of group I [90%]. Modifications required to accomplish the procedure in group I of patients included mainly partial decompression of the gall bladder [85%], the use of toothed graspers [85%] and enlargement of the port of exit of the specimen [80%]. Two patients of group I [10%] required conversion to open surgery [because of the presence of tough difficult adhesions obscuring the anatomy]. The operative time for group I was longer than that for group II, [98 +/- 30.4] and [66.4 +/- 17.7] min respectively. Postoperative course and recovery was similar in successful laparoscopic procedures of both groups except for a longer hospital stay for group I of patients [55.3 +/- 8.4 hours and 30 +/- 6.2 hours respectively]. There was no major postoperative morbidity or mortality in both groups. Patients of group I operated upon within three days of onset of symptoms had less operative difficulties, less intraoperative complications and less operative time compared to those operated upon after three days of onset [4-7]. Follow up revealed no complications related to surgery in both groups. Conclusions: Laparoscopic cholecystectomy is technically feasible for the management of majority of cases of early acute calcular cholecystitis with no added risks. It is better performed within the first three days of onset of symptoms. The operation is technically demanding time and effort consuming so should only be offered by experienced surgeons and conversion to open surgery should be interpreted as a wise alternative to potential serious complications