Abdul Aziz Laghari, Arshad M Malik, Taf Talpur K Altaf, Ahmed Khan Sangrasi, Jan Mohammad Memon, Sharjeel Abbas Dahri.
Emergency laparoscopic cholecystectomy in acute cholecystitis.
Pak J Surg Jan ;23(1):18-22.

Objective: To assess the applicability of Laparoscopic Cholecystectomy in Acute Cholecystitis. Design & Duration: Prospective observational study from July 2001 to June 2006. Setting: Surgical units at Liaquat University Hospital and Private Hospitals of Hyderabad. Patients: All patients with Acute Cholecystitis who underwent Laparoscopic Cholecystectomy. Methodology: All patients with acute gall bladder symptoms, irrespective of age and sex, underwent clinical evaluation and appropriate investigations. Patients with stones in the common bile duct, carcinoma gall bladder and chronic liver disease with ascites, and those who were unfit patients were excluded from this study. All patients underwent laparoscopic surgery and the outcome analyzed. Results: In this five years study 830 patients were admitted with gall stone disease. Amongst them 200 cases (24.09%) presented with acute cholecystitis; 65(32.5%) being males and 135(67.5%) females. Pain (100%), vomiting (35%) and fever (27.5%) were common symptoms at presentation. On laparoscopy, adhesions to omentum were present in 77.41% of the cases. Various grades of inflammation were noted varying from simple inflammation in 55% to necrotic patches on the gall bladder in 11%, empyema in 30% and gangrenous gall bladder in 4%. Majority (80%) of the cases underwent surgery within 48 hours of admission. Problems encountered during surgery were profuse bleeding (17%), perforation of gall bladder (11.5%), cystic duct avulsion (1.5%) and bile duct injury (1%); conversion to open surgery was resorted to in 5.5% cases. Post operative complications included bleeding (9%), vomiting (17.5%) and bile leakage (4%). The hospital stay was between 2 days to >5 days (mean stay=2.81 days). There was no mortality in this series. Conclusion: Emergency laparoscopic cholecystectomy in acute cholecystitis is safe and cost effective. However, adequate experience of the operating surgeon is mandatory.

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