Comparative Study of Outcomes of Early Versus Interval Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 4
Abstract
Background And Objectives: To compare the overall efficacy, mortality and morbidity in patients managed with early versus delayed laparoscopic Cholecystectomy for acute calculus Cholecystitis. Methods: A total of 50 patients were chosen for the study. They were selected on the bases of presence of two of the following four features: (1) Abdominal pain characteristic of Acute Cholecystitis, (2) Positive Murphy’s sign, (3) Total Leucocyte Count > 10,000/ uL, and (4) Ultra-sonographic evidence of Acute Calculus Cholecystitis. Patients were selected on the bases of Initial surgical management planned for laparoscopic cholecystectomy whether in immediate or interval Cholecystectomy. Patients with other complications of Cholecystitis, other abdominal pathologies and surgeries were excluded from the study. Patients were divided into 2 study groups by odd-even method of randomization and they were categorized as Group A and Group B alternatively as per their primary surgical OPD presentation sequence. Immediate cholecystectomy was performed in Group A patients while interval cholecystectomy after initial conservative management was done in Group B patients. Results: The mean age of presentation for acute calculus cholecystitis was found to be 48.4±14.2 years with 36% of male patients and 64% of female patients of total patients. The Conversion of laparoscopic to open cholecystectomy rate was 8% in early cholecystectomy group as compared to 4% in interval cholecystectomy group in our study. There was a significant shorter operative duration in interval cholecystectomy as compared to early cholecystectomy. The hospital stay was significantly longer in patients of interval cholecystectomy than early cholecystectomy. The intra operative and postoperative complications like bile and gall stone spillage due to gall bladder perforation, hemorrhage, biliary fistula and wound infection were more common with early than interval laparoscopic cholecystectomy. Complications like biliary fistulas occurred in patients operated for early cholecystectomy and not in interval cholecystectomy. The requirement of antibiotics and analgesics were significantly higher in interval cholecystectomy group as compared to early cholecystectomy group. No mortalities were recorded in either group. Interpretation and Conclusion: There is no significant difference in overall clinical outcome in patients managed by immediate and interval cholecystectomy in case of acute calculus cholecystitis. The total hospital stay and medication requirement are higher in interval cholecystectomy group as compared to early cholecystectomy group.Overall morbidity is higher in interval cholecystectomy group patients.Intraoperative difficulty, postoperative morbidity and complications are higher in immediate cholecystectomy group.Patients should be planned for immediate or interval cholecystectomy according to their symptomatic severity and willingness to undergo early surgery or initial conservative management.
Authors and Affiliations
Kirit D Parmar, Mitul V Patel, Sameer I Bengali
Keywords
Related Articles
- EP ID EP595593
- DOI 10.9790/0853-1604096873.
- Views 48
- Downloads 0
Young Adolescent Male Patient of Systemic Lupus Erythematosus Presenting With Lupus Nephritis: A Case Report
Systemic lupus erythematosus is a rare and chronic autoimmune disorder characterized by multisystem inflammation and presence of circulating autoantibodies directed against self antigens. SLE occurs in both children and...
Immediate placement of Implant in Fresh Extraction Socket: A Case Report
Loss of tooth in the aesthetic zone is a traumatic experience with or without compromise in phonetics. Implant placement in anterior region has most aesthetic challenges in implant dentistry because tooth loss leads to b...
“A Comparative Study Between Biers’ Block And Supraclavicular Brachial Plexus Blockfor Upper Limb Below Elbow Surgeries”
Background And Objectives: Regional anaesthesia is becoming more popular especially with the advent of safer drugs and techniques; This study was conducted in elective surgeries of upper limb below the elbow to compare t...
Serum Vitamin D Levels in Acute Stroke Patients At RIMS, Ranchi, Jharkhand, India.
Introduction: Vitamin D has been associated with mineral homeostasis and musculoskeletal health. However many studies have described the extra- skeletal effects of the vitamin D, like low levels of vitamin D have been as...
Application of Intracanal Medicaments: A Review
Elimination of microorganisms from the root canal is the main procedure for endodontic treatment. Cleaning and shaping is not so much effective for reducing bacterial count in root canals. This procedure may fail due to...