Complications of laparoscopic cholecystectomy in acute cholecystitis

ABSTRACT

To assess the clinical outcome of laparoscopic cholecystectomy in the management of acute cholecystitis. Descriptive study. Surgical Units II and III of Chandka Medical College Hospital Larkana, from 01.10.2003 up to 31.12.07. In this study 100 consecutive cases of clinically and sonologically confirmed acute cholecystitis who underwent early laparoscopic cholecystectomy [within 07 days of attack] were included. Patients with symptoms of more than one week duration or those with associated diseases were excluded. There was female preponderance with male to female ratio 14.5. Mean age was 45.75 years [SD +/- 11.99 years]. Most of the patients were received within 24 hours after the onset of symptoms. Ultrasound revealed edematous gall bladder [GB] in 24 cases, contracted GB in ten, empyema in eight, perforated GB in four. Fifty four patients had acute cholecystitis with cholelithiasis. Peroperative complications were minor bleeding in 6 patients, minor injury to liver bed in 3, major bleeding occurred in two cases that required conversion to open surgery .Other findings which delayed the procedure or required conversion were adhesions with omentum, stomach, colon, CBD, and distorted anatomy of Calot's triangle and CBD injury. The conversion rate was 6% among them two were due to bleeding, two with friable adhesions, one with obscure anatomy. Stone in CBD could not be detected on ultrasound in one case and CBD injury occurred in one. The minimum time taken for the procedure was 50 minutes. No mortality occurred in this series. Emergency / early cholecystectomy is reliable, safe and cost effective modality, in the management of acute cholecystitis. It results in accelerated recovery, negligible wound infection or related complications, and less postoperative pain. Certain factors are responsible for conversions which are obscure anatomy, bleeding, adhesions, and CBD, injury