Comparison of early and delayed laparoscopic cholecystectomy for acute cholecystitis: experience from a single center.

BACKGROUND: Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis. AIMS: To evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy. MATERIALS AND METHODS: This was a prospective and randomized study. For patients assigned to early group, laparoscopic cholecystectomy was performed as soon as possible within 72 hours of admission. Patients in the delayed group were treated conservatively and discharged as soon as the acute attack subsided. They were subsequently readmitted for elective laparoscopic cholecystectomy 6-12 weeks later. RESULTS: There was no significant difference in the conversion rates, postoperative analgesia requirements, or postoperative complications. However, the early group had significantly more blood loss, more operating time, and shorter hospital stay. CONCLUSION: Early laparoscopic cholecystectomy within 72 hours of onset of symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

A medical school experience with three port laparoscopic cholecystectomy with a new modification in technique.

INTRODUCTION: The three port laparoscopic cholecystectomy is a recognized entity in the surgical management of gallstone disease. We report our experience and feasibility of three port laparoscopic cholecystectomy with a new modification in technique. METHODS: To assess the feasibility and safety of three-port laparoscopic cholecystectomy with a different port placement, we undertook a prospective study with 50 patients at government medical college, Srinagar, Kashmir, India between Jan 2010 and Jan 2011. Our study offered a benefit of concealed third port designed around umbilicus over the conventional three port laparoscopic cholecystectomy. A single surgeon did all the cases and definite criteria of simple cases of gallstone disease patterned on clinical and radiological grounds. RESULTS: 50 cases of gallstone disease were subjected to the new technique of three port laparoscopic cholecystectomy during a period one year. 34 cases were females and 16 were males. The age range of our patients was between 20 and 55 years with the median age of 33 years. Mean Body mass index 30 (range 25-35). Mean operative time was 30 min (range 15-45 min) and a follow up [period ranged from 9 to 12 months]. No cases were converted to open though two cases required an additional port in the right hypochondrium for retraction. We did not encounter any untoward mishaps during surgery. CONCLUSION: Three port laparoscopic cholecystectomy with our modification of the third port placement at a different site received good results and patient satisfaction. Moreover the placement of third port at a consealed area around umbilicus apparently gives it an appearance of two port laparoscopic cholecystectomy with an addition of technical ease.