Laparoscopic Cholecystectomy in Acute Cholecystitis :An Experience with 100 cases

The introduction of laparoscopy in the surgical field has undoubtedly been the biggest revolution in the history. Since the performance of first laparoscopic cholecystectomy by Prof Dr Med Erich Mühe of Böblingen, Germany 1985, this procedure overtook as the new gold standard for the management of cholelithiasis. The management of cholelithiasis has undergone radical changes since its recognition; from medical management of stones to the surgical removal of the gallbladder. Earlier open cholecystectomy had been the treatment of choice; though it was recommended after a rest period of 6 weeks after an acute attack. Now-adays laparoscopic cholecystectomy has replaced the open procedure as the first line management. Despite the wellaccepted success of laparoscopic cholecystectomy in elective treatment of symptomatic cholelithiasis, the efficacy and timing of this technique has been subject to some debate in the setting of acute cholecystitis. Initial reports suggested that early laparoscopic surgery for acute cholecystitis was associated with increased Introduction Abstract This study was undertaken to evaluate our experience with laparoscopic cholecystectomy in the setting of acute cholecystitis. Between one year, one hundred patients with clinical, laboratory and radiological evidence of acute cholecystitis underwent early laparoscopic cholecystectomy within three days of onset of symptoms in a prospective study. The mean (range) age was 54 (28-61) years and the male female ratio was 3.7:6.3. The primary outcomes studied were operative time, blood loss, ease of surgery, conversion to open cholecystectomy, complications, length of hospital stay and the return to work. There were no major complications or any deaths during the study. There were two conversions in total. In one case it was due to difficult anatomy and for the control of bleeding in the second case. The mean (range) operative time was 71 (45-118) min. The mean (range) blood loss was 85 (50-350) ml. The mean (range) hospital stay was 3 (2-6) days. All patients returned back to routine work within 2 weeks of surgery. The mean followup was 6 (3-11) months. Laparoscopic cholecystectomy performed by experienced surgeons is a safe, effective technique for treatment of acute cholecystitis. Patients treated within 72 hours of onset of symptoms experience a lower conversion rate to an open procedure, shorter operative time and reduced hospitalization in addition to avoiding second hospitalization for surgery.