Jahangir Sarwar Khan, Usman Qureshi, Mohammed Mussadiq Khan, Mohammed Iqbal.
Comparative Audit of Laparoscopic Cholecystectomy: A Local Experience.
Ann Pak Inst Med Sci Jan ;9(3):130-4.

Objective: To determine the efficacy of laparoscopic cholecystectomy in our settings, the main complications associated with it, the reasons for conversion to open cholecystectomy and the duration of hospital stay, in a Comparative Audit between Group A and Group B, each comprising 1000 patients, Design: Descriptive study. Place and Duration of Study: Surgical Department, Rawalpindi Medical College and the author’s Surgical Clinics from January 1998 to December 2112. Materials and Methods: One thousand patients undergoing laparoscopic cholecystectomy, were included in each group .The initial 1000 cases operated between January 1997 to December 2007, were included in Group A whereas subsequent 1000 patients operated between January 2008 to December 2012, were included in B group. The important variables included demographic data, intra operative time and findings, causes of conversion to open cholecystectomy and reasons for it, post operative hospital stay, morbidity and mortality associated with the procedure. Results: There were 833 females and 117 males with mean age 45±11 years in A Group whereas there were 840 females and 160 males in B Group with mean age 44+_10.(p>.05) In Group A, 66.6% patients had chronic cholecystitis with cholelithiasis and were admitted through Out Patient Department whereas 33.4% were admitted through Accident and Emergency Department with acute cholecystitis while in Group B it was 69% and 31% respectively.(p>.05) Abdominal ultrasound showed multiple calculi in 745 (74.5%) patients and 255 (25.5%) patients had single calculus preoperatively in Group A whereas it was 79% and 21% in Group B.(p>.05) Empyema was found in 136(13.6%) cases in Group A versus 185 (18.5%) in Group B (p>.05) whereas adhesions were present in 403(40.3%) patients in Group A against 380 (38%) in Group B. In Group A conversion rate was 4.8% versus 1.5% in Group B. Frequency of CBD injury was 1.4% in Group A which reduced to only .3% in Group B. Mean operating time was 40 minutes and 20 minutes in Group A and Group B respectively. 72.9.% of the patients were discharged within 24 hrs of operation in Group A versus 86.2% in Group B. In Group A, there was no mortality while morbidity was 6% but in Group B,the mortality was 0.5% and morbidity of 4%. Conclusion: Laparoscopic Cholecystectomy in our set up have shown marked improvement in results in last 17 years despite all constraints.

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