Anwar-ul Haque, Nisar Ali, Muhammad Ismail, Manzoor Ali, Shahid Alam, Muhammad Nadeem, Mohsin Ali, Mahboob Ahmad Khan, Bahroz Khan.
Early experience of laparoscopic cholycystectomy at Saidu Teaching Hospital Saidu Sharif Swat.
J Saidu Med Col Jan ;7(1):47-51.

BACK GROUND: Gallstone disease is a common problem in Swat and adjacent districts of Khyber Pakhtunkhawa province of Northern Pakistan. About 10 to 15% of the population is having asymptomatic gall stones out of which 1 to 2% become symptomatic each year. Laparoscopic cholecystectomy has rapidly become the procedure of choice for routine gall bladder removal and is currently the most commonly performed major abdominal procedure in western countries1. OBJECTIVE: To study the outcome of early cases of laparoscopic chlecystectomy by general surgeons at Saidu Teaching Hospital. MATERIAL AND METHODS: All the consultant surgeons of our unit from senior registrar to professor attended workshops on basic laparoscopic skills and laparoscopic cholecystectomy and started performing laparoscopic cholecystectomies. The data of first 100 cases which were randomly selected for laparoscopic cholecystectomy between January 2015 and June 2016 was recorded. This included operation time, complication and difficulties during surgery including conversion to open cholecystectoy, post operative pain and complication including port site infection, hernia and intra abdominal collection. RESULTS: The first 100 patients on whom laparoscopic cholecystectomy was performed had a mean age of 44.35 + 15 years.14(14%) were male while 86 (86%) were females. 33% had acute cholecystitis while 67% were suffering from chronic cholecystitis. 9% had hypertension and 11% had diabetes as a comorbid condition. The mean operating time was 80 +30 minutes. Critical view of safety was displayed in 93% of patients. Clips were applied to the cystic artery and duct in 90 % while Roeder's knot was used in 6% of the patients and 4% were converted to open cholecystectomy. Irrigation was used in 21(21.87%) of the patients and drain was placed in 3 (3.12%) of the patients. Gall bladder was removed through epigastric port in 16.67% and via the umbilical port in 83.33% of the patients.20 % of the patients had dense adhesions. Empyema was present in 4% of the patients. Cystic artery could not be identified separately in 3% of the patients. Bleeding from cystic artery occurred in 2(2%) of the patient and one of them was converted into open cholycystectomy. Partial cholecystectomy was done in 1 patient. None of the patients had injury to the common bile duct or bowel. 15.6% of patients remained pain free. While pain was mild in 48%, moderate in 30% and severe in 3.12% of the patients managed with an additional dose of narcotic analgesic. 3.12% of the patient developed intra abdominal abscess which was aspirated under ultrasound guidance and drain was placed in one patient. 2.08 % patients had epigastric port infection. Umbilical port infection was present in 3.13% and lateral port infection was present in 1.04 % of the patients. There was no mortatility in patients in whom laparoscopic cholecystectomy was completed. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective procedure for both acute and chronic cases of cholecystitis and even for empyema or mucocele of gall balder if performed by experienced surgeons. Experienced general surgeons can safely start performing laparoscopic cholecystectomy after attending workshops on basic laparoscopic skills and laparoscopic cholecystectomy and watching lectures and videos on internet. Keywords: Laparoscopic cholecystectomy, outcome, laparoscopy, critical view of safety, Calot's triangle

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