Over view of laparoscopic cholecystectomy at [SMBBMU] University Hospital Larkana 1920 cases

ABSTRACT

To evaluate the safe technique in patient with cholelithiasis either simple or with acute cholecystitis and to highlight the better method in which patient can be prevented from future complication. Experimental Study. This study was conducted at University Hospital of Shaheed Mohtrama Benazir Bhutto Medical University, Larkana with effects from Jan 2005 to Jan 2011. Total number patient 1920 underwent lap chole, while 184 were admitted in acute state from casualty and Out Patient Department of university hospital. The mean age was 11-75 years, male and female ratio 13 with regard the 184 in acute cholecystitis among those patients reach to hospital within 24hours were 85, from 24-48hours were 65 patients while from 48-72 hours were 34 patients. While remaining patient were managed as elective cases. The operative time taken in elective cases were 30 minutes but in acute cases it was 90 minutes so average time was 60 minutes. The overall conversion rate is 2.86% but in acute case the conversion rate 8.15%. Post operative average hospital, stay remain's 1 day in elective cases but in acute Cholecystitis where conversion to open were performed the hospitalization minimum 6 maximum 7 days. The wound infection seen in 49 cases [2.8%]. Lap chole is a reliable and safe in management of cholecystitis either with or without cholelithiasis having simple or acute cholecystitis, while certain factors are responsible for conversion include delayed arrival more than 72 hours, empyema and bleeding while contradictory to international literature our study suggest that conversion rate is high in acute rather than elective Cholecystitis. So it is concluded that emergency lap chole is a safe and cost effective due to on time surgery and patient can be prevented from future complication. Therefore early lap chole is safe and can be performed in simple and complicated Cholecystitis while literature have proved that lap chole also safe in pregnant lady with certain limitation of like height of fundus