Manoj Kr. Choudhury. GNRC Hospitals
Introduction: Laparoscopic cholecystectomy in acute cholecystitis within 72 hrs has been the accepted practice, but lap chole beyond 72 hours has not been accepted due to increased risk of complications .Patients from periphery in our part of the world reach late for treatment due to poor connectivity, economic backwardness, and lack of awareness and pose a treatment dilemma. We took up these cases with various durations and severity and performed laparoscopic cholecystectomy to analyze the results and outcome.
Method and Procedure: 843 cases of acute cholecystitis out of 3560 lap. Chole performed during the period from September, 2008 to august, 2015 were taken up for analysis. Choledocholithiasis, acute pancreatitis and those who refused early surgery were excluded from the study.
After complete work up, cases were categorized as acute ( upto 7 days) and unresolved acute cholecystitis” ( 7 days to 2 months ) and others (60 days onwards). Severity was classified as mild, moderate and severe (Tokyo guideline). Ultrasound was the routine diagnostic test. CT scan and MRI was done in selected cases Acute cholecystitis with signs of sepsis was treated with antibiotics for 48 hours prior to surgery. Patients with organ dysfunction were stabilized by multi-disciplinary team. Lap Cholecystectomy was performed with four ports technique. Duration of surgery, complications and the hospital stay were recorded.
Results: Male and female ratio was 38.22% and 61.78% respectively. Record showed 280( 33.17% ) cases were acute, 366 ( 43.41% )“ unresolved acute cholecystitis” ( 7 days to 2 months ) and 197( 23.41% ) cases ( 60 days onwards) . As per Tokyo 2007 guide line 584 (69.27% ) mild, 201 (23.90%) moderate, 58 (6.83%) severe cases were found. Duration of surgery performed within 60 minutes was 48.9% in acute cases (96.1% Routine LC). We had two billiary injury in acute group, overall converted 3 cases and had post operative sepsis 3 cases. Av. Hospital stay was 2 days (1-5 days)
Conclusion: We did not find significant difference in results of treatment in regards to duration of symptoms and severity. No significant difference was noted in complication and conversion rate. Duration of surgery and hospital stay differed significantly in acute, unresolved and elective category. (p value being 0.0001)