Comparative Study of Outcomes of Early Versus Interval Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 4
Abstract
Background And Objectives: To compare the overall efficacy, mortality and morbidity in patients managed with early versus delayed laparoscopic Cholecystectomy for acute calculus Cholecystitis. Methods: A total of 50 patients were chosen for the study. They were selected on the bases of presence of two of the following four features: (1) Abdominal pain characteristic of Acute Cholecystitis, (2) Positive Murphy’s sign, (3) Total Leucocyte Count > 10,000/ uL, and (4) Ultra-sonographic evidence of Acute Calculus Cholecystitis. Patients were selected on the bases of Initial surgical management planned for laparoscopic cholecystectomy whether in immediate or interval Cholecystectomy. Patients with other complications of Cholecystitis, other abdominal pathologies and surgeries were excluded from the study. Patients were divided into 2 study groups by odd-even method of randomization and they were categorized as Group A and Group B alternatively as per their primary surgical OPD presentation sequence. Immediate cholecystectomy was performed in Group A patients while interval cholecystectomy after initial conservative management was done in Group B patients. Results: The mean age of presentation for acute calculus cholecystitis was found to be 48.4±14.2 years with 36% of male patients and 64% of female patients of total patients. The Conversion of laparoscopic to open cholecystectomy rate was 8% in early cholecystectomy group as compared to 4% in interval cholecystectomy group in our study. There was a significant shorter operative duration in interval cholecystectomy as compared to early cholecystectomy. The hospital stay was significantly longer in patients of interval cholecystectomy than early cholecystectomy. The intra operative and postoperative complications like bile and gall stone spillage due to gall bladder perforation, hemorrhage, biliary fistula and wound infection were more common with early than interval laparoscopic cholecystectomy. Complications like biliary fistulas occurred in patients operated for early cholecystectomy and not in interval cholecystectomy. The requirement of antibiotics and analgesics were significantly higher in interval cholecystectomy group as compared to early cholecystectomy group. No mortalities were recorded in either group. Interpretation and Conclusion: There is no significant difference in overall clinical outcome in patients managed by immediate and interval cholecystectomy in case of acute calculus cholecystitis. The total hospital stay and medication requirement are higher in interval cholecystectomy group as compared to early cholecystectomy group.Overall morbidity is higher in interval cholecystectomy group patients.Intraoperative difficulty, postoperative morbidity and complications are higher in immediate cholecystectomy group.Patients should be planned for immediate or interval cholecystectomy according to their symptomatic severity and willingness to undergo early surgery or initial conservative management.
Authors and Affiliations
Kirit D Parmar, Mitul V Patel, Sameer I Bengali
Keywords
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- EP ID EP595593
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