Basrah Journal of Surgery (Jun 2018)
COMPARISON OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS: EXPERIENCE FROM TWO CENTERS IN BASRAH
Abstract
COMPARISON OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS: EXPERIENCE FROM TWO CENTERS IN BASRAH Habeeb Flayyih Hussein@, Rafid Abduljabbar Mohammed$, Mushtaq C Abu-Al-Hail#, & Omran S Habib% @MB,ChB, CABS, General and Laparoscopic Surgeon, Alsadr Teaching Hospital. $MB,ChB, CABS, MRCS, General Surgeon and Lecturer at Basrah College of Medicine. #MB,ChB, CABS, Consultant General and Laparoscopic Surgeon, Basrah Teaching Hospital. %PhD, Professor of Epidemiology and Health Care, Department of Community Medicine, Basrah College of Medicine, Basrah, IRAQ. Abstract Calculous cholecystitis is a major and common health problem, and nowadays laparoscopic cholecystectomy is the preferred approach for its surgical management but timing of surgery is a matter of debate especially in presence of acute inflammation of the gall bladder. The aim of this study is to compare the outcome of early and delayed laparoscopic cholecystectomy for acute cholecystitis. This retrospective comparative study was done in two tertiary hospitals in Basrah from July 2010 to July 2017. It involved 122 cases (98 females 80.3% and 24 males 19.7 %). Forty two (34.5%) underwent early laparoscopic cholecystectomy within 4 days of symptoms and 80 patients (65.5%) underwent delayed operation within 6-12 weeks of first presentation. The two groups were comparable in regard to demographic and clinical points of view. The age of studied patients lies between 20-65 years. The operative time was not identical for the two groups (P=0.004), early treated cases tended to take longer operative time. Hospital stay was significantly longer in early cases as compared to delayed cases (p=0.000). Bile leak happened in only one case (2.4%) of the early group and was managed successfully and discharged well. Bleeding and respiratory infection were extremely rare in both groups. Conversion rate was 4.8% and 5% for the early and delayed group respectively and the difference was statistically not significant (p value 0.661). In conclusion, early laparoscopic cholecystectomy in acute cholecystitis is safe and feasible in selected patients with no difference in morbidity and mortality if it done during the 1st four days of beginning of symptoms, but the operative time is longer than delayed operation.
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