Evaluation of early versus interval laparoscopic cholecystectomy in acute calculus cholecystitis
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RANDOMISED PROSPEC TIVE TRIAL
Evaluation of Early Versus Interval Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis Anand Rai Bansal, Vikas Arora, Amit Dangi, Rajesh Godara
Abstract Aim -Background: The aim of the study is to assess the feasibility of the early laparoscopic approach in acute cho-
lecystitis. Even today, most surgeons throughout the world would rather perform laparoscopic cholecystectomy during the quiescent phase of cholecystitis. With the introduction of laparoscopy to the surgical management of gallstone disease, acute cholecystitis was initially considered to pose certain technical challenges for the surgeon and potential risks to the patient, and was thus considered a contraindication. Aim: To assess the feasibility of the early laparoscopic approach in acute cholecystitis. Material and Methods: The study involved fifty patients who presented with acute calculus cholecystitis between
July 2010 to December 2012. All the patients were divided into two groups by computer-generated randomisation. Group A included 25 patients treated by early laparoscopic cholecystectomy, i.e. who were operated on within three days (72 hours) of the onset of symptoms. Group B included 25 patients initially managed with conservative treatment followed by interval cholecystectomy within 4-6 weeks at the second admission. Results: In the early laparoscopic cholecystectomy group, the patients' age was 44.52 ± 14.14 years with a range of
21 to 70 years and in the interval laparoscopic group, it was 45.68± 12.10 with a range of 25 to 65 years. The mean duration of surgery in the early group was 70.32 ± 18.51 minutes as compared to 66.48 ± 16.22 minutes in the interval group (p value > 0.05). Three patients in the early group and one in the interval group required conversion to open surgery because of adhesions, difficult anatomy, and the inability to dissect in Calot’s triangle. No mortality and major morbidity was observed in either group. Conclusion: Both early and interval cholecystectomy performed by experienced surgeons proved safe and effective
for the treatment of acute cholecystitis. Early laparoscopic cholecystectomy can offer a major long-term benefit in terms of hospital economics because of a markedly reduced total hospital stay. Key words: Laparoscopy, cholecystectomy, acute cholecystitis
INTRODUCTION Nowadays, one of the most prevalent surgical entities to afflict populations of industrialized countries is gallbladder inflammatory disease, i.e. cholecystitis. The most common cause of cholecystitis is cholelithiasis. Autopsy reports have shown a 11-35% prevalence of gallstones [1]. About 10-15% of adult western population have gallstones [2]. A relevant survey in India suggested that gallbladder stones are at least
Anand Rai Bansal Professor, MBBS, MS, FAIS, Vikas Arora Senior Resident, MBBS, MS, Amit Dangi Senior Resident, MBBS, MS, Rajesh Godara Professor, MBBS, MS, DNB, FAIS, FICS Department of Surgical Discipline, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Harya
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