Rafique Memon, Samina Rafique Memon, Aftab Ahmed Soomro, Syed Qarib Abbas Shah.
Experience of laparoscopic cholecystectomy at Sukkur.
Med Channel Jan ;16(2):290-4.

OBJECTIVE: This study was undertaken to evaluate our institution’s experience with Laparoscopic cholecystectomy as a safe and effective treatment for acute and chronic calculus cholecystitis in terms of post operative pain, operative time, rate of conversion and complications. STUDY DESIGN: A prospective observational study. PLACE AND DURATION OF STUDY: This study was conducted at Ghulam Muhammad Mehar Medical College and Hira Medical Centre Sukkur, during a period of last four years, from Jan 2006 to Dec 2009. PATIENTS AND METHODS: It is a prospective study, including 1000 patients undergoing Laparoscopic surgery for symptomatic cholelithiasis. Patients included in the study were divided into two groups. Group I patients presented with chronic cholecystitis (700 patients), while Group II patients presented with acute gallbladder disease (300 patients). Patients with obstructive jaundice, choledocholithiasis, cholangitis, portal hypertension, and gallbladder malignancy were excluded from the study. RESULTS: Among 1000 patients there are 205 (20.5%) males and 795 (79.5%) females. The mean age was 45 years. The male: female ratio was 1:4. In this study, the laparoscopic cholecystectomy was done for chronic calculus cholecystitis in 700 patients, for acute calculus cholecystitis in 282 patients and acute acalculus cholecystitis in 18 patients. The median of hospital stay were 2 and 3 days in chronic cholecystitis and acute cholecystitis respectively (mean were 1.9 versus 3.2 days) [P= 0.0005]. The median of postoperative stay were 0.83 and 1 day in chronic and acute settings respectively (means 0.82 ± 0.62 versus 1.82 ± 2.9 days) [P= 0.0005]. The open conversion was in 3 (0.428%) patients out of 700 with chronic cholecystitis, while in 5 (1.66%) out of 300 patients with acute cholecystitis. The mean operation time were 39.9 ± 18.8 and 57.8 ± 29.2 minutes in chronic and acute cholecystitis respectively (P=0.0005). Minimal complications were observed in the chronic group, while major complications like CBD injury and retained CBD stones along with postoperative biliary collections were found in the acute group. Wound infection occurred in 3.9%. No mortality found in the study. CONCLUSION: Laparoscopic cholecystectomy is superior and beneficial to open cholecystectomy in terms of less postoperative pain, decreased hospital stay, early return to work and minimal complications. It is cost-effective and safe with less postoperative morbidity. So, it is a procedure of choice for gallbladder disease.

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