LAPAROSCOPIC CHOLECYSTECTOMY: EXPERIENCE AT A TERTIARY LEVEL HOSPITAL
AbstractBackground: Cholecystectomy is the most frequently performed abdominal operation and currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in 90% cases of symptomatic gallstones in USA since 1992. The aim of the study was to determine results obtained with LC at our setup. Methods: This observational case series study was conducted in department of General Surgery, Combined Military Hospital, Rawalpindi, from August 2009 to August 2011. The study participants were patients of both gender aged 14–75 years undergoing LC. Surgery was performed by consultant as well as resident surgeon. Demographic variables, intraoperative findings, mean operation time, hospital stay, conversion rate, morbidity and mortality were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 504 patients were included. Mean age was 42.64 years (range 14–75 years) with a female: male ratio of 3.9:1.2. Comorbidities were found in 36.7% patients. Main indication of surgery was symptomatic cholelithiasis (78.57%). Mean operative time was 40.1±6.9 minutes which increased to 75.12±8.9 minutes in converted cases (p-value .000). Mean hospital stay was 1.89±1.1 days that significantly increased in converted cases (5.7±1.6 days) (p-value .000). Major surgical complications occurred in 3.17% patients. Common bile duct injury (CBDI) was found in 04 cases (0.79%). Conversion to laparotomy was required in 3.97% cases. Factors that influenced the rate of conversion included: age>60 years, acute cholecystitis, coexisting diseases, ASA grade III/IV and inexperienced surgeon (p-value .000). Total complication rate was 3.56%, morbidity being 3.17% and mortality 0.39%.Conclusion: Laparoscopic cholecystectomy offers shorter hospital stay and low morbidity/ mortality. The operative time is short and procedure is standard, safe and effective method both for uncomplicated and complicated cholelithiasis.Keywords: Laproscopic, cholecystectomy, safety, complications, conversion, morbidity, mortality
Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 2006;20:981–96.
Kratzer W, Mason RA, Kachele V. Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound1999;27:1–7.
Stinton LM, Myers RP, Shaffer EA. Epidemiology of Gallstones. Gastroenterol Clin North Am 2010;39:157–69.
Proceedings of the NIH Consensus Development Conference on Gallstones and Laparoscopic Cholecystectomy, Bethesda, Md, September14-16, 1992. Am J Surg 1993;165:387–548.
Mühe E: Die erste Cholezystektomiedurchdas Laparoskop, Kongressbericht 69. Langenbecks Arch Chir 1986;369:804.
Mouret P. From the first laparoscopic cholecystectomyto the frontiers of laparoscopic surgery:the future prospectives. Dig Surg. 1991; 8:124–5.
NIH. Gallstones and laparoscopic cholecystectomy, NIH Consensus Statement, 14-16 Sept, 1992. http://consensus.nih.gov/1992/1992gallstoneslaparoscopy090html.htm
Nenner RP, Imperato PJ, Rosenberg C, Ronberg E. Increased cholecystectomy rates among Medicare patients after the introduction of laparoscopic cholecystectomy. J Community Health 1994;19:409–15.
Villeta Plaza R, Landa Garcia JI, Rodriguez Cuellar E, Alcalde Escribano J, Ruiz Lopez P. National project for the clinical management of healthcare processes. The surgical treatment of cholelithiasis. Development of a clinical pathway. Cir Esp 2006;80:307–25.
Kaafarani HM, Smith TS, Neumayer L, Berger DH, Depalma RG, Itani KM. Trends, outcomes, and predictors of open andconversion to open cholecystectomy in Veterans Health Administration hospitals. Am J Surg 2010;200:32–40.
Keus F, De Jong JA, Gooszen HG, Van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 2006;4:CD006231.
Cuschieri A, Terblanche J. Laparoscopic cholecystectomy: evolution, not revolution. Surg Endosc 1990;4:125–6.
Shamiyeh A, Wayand W. Laparoscopic cholecystectomy: early and late complications and their treatment. Langenbecks Arch Surg 2004;389:164–71.
Gigot JF. Bile duct injury during laparoscopic cholecystectomy:risk factors, mechanisms, type, severity and immediatedetection. Acta Chir Belg 2003;103:154–60.
Hasson HM. A modified instrument and methodfor laparoscopy. Am J Obstet Gynecol 1971;110:886–7.
Avgerinos C, Kelgiorgi D, Touloumis Z, Baltatzi L, Dervenis C. One thousand laparoscopic cholecystectomies in a singlesurgical unit using the “critical view of safety” technique. J Gastrointest Surg 2009;13:498–503.
Almutairi AF, Hussain YA. Triangle of safety technique: anew approach to laparoscopic cholecystectomy. HPB Surg 2009;ID476159.
Vettoretto N, Saronni C, Harbi A, Balestra L, Taglietti L, Giovanetti M. Critical View of Safety During Laparoscopic Cholecystectomy. JSLS 2011;15:322–5.
Bessa S, Al-Fayoumi T, Katri K, Awad A. Clip less laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech 2008;18(4):593-8.
Gelmini R, Franzoni C, Zona S, Andreotti A, Saviano M. Laparoscopic cholecystectomy with Harmonic Scalpel. JSLS 2010;14:14–9.
Yano H, Okada K, Kinuta M, Nakano Y, Tono T, Matsui S, et al. Efficacy of absorbable clips compared with metal clips for cystic duct ligation in laparoscopic cholecystectomy. Surg Today 2003;33:18–23.
Nathanson LK, Easter DW, Cuschieri A. Ligation of the structures of the cystic pedicle during laparoscopic cholecystectomy. Am J Surg 1991;161:350–4.
Kim HO, Yun JW, Shin JH, Hwang SI, Cho YK, Son BH, et al. Outcome of laparoscopic cholecystectomy is not influenced bychronological age in the elderly. World J Gastroenterol. 2009;15:722–6.
Cheng SP, Chang YC, Liu CL, Yang TL, Jeng KS, Lee JJ, et al. Factors associated with prolonged stay after laparoscopiccholecystectomy in elderly patients. Surg Endosc 2008;22:1283–9.
Malik AM, Laghari AA, Talpur KA, Memon A, Pathan R, Memon JM. Laparoscopic cholecystectomy in the elderly patients: Anexperience at Liaquat University Hospital Jamshoro. J Ayub Med Coll Abbottabad 2007;19(4):45–8.
Loureiro ER, Klein SC, Pavan CC, Almeida LDLF, Silva FHP, Paulo DN. Laparoscopic cholecystectomy in 960 elderly patients. Rev Col Bras Cir 2011;38:155-9.
Amaral PCG, Ázaro Filho EM, Fortes MF, Ettinger E Jr, Cangussu HC, Fahel E. Taxas de complicações e tempo de permanência hospitalar foram maiores em pacientes idosos submetidos à videolaparocolecistectomia. Resultados após colecistectomia videolaparoscópica em pacientes idosos. Rev bras videocir 2006;4(2):48–53.
Strasberg SM. Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg 2008;15:284–92.
Katkhouda N, Mavor E, Mason RJ. Visual identification of thecystic duct-CBD junction during laparoscopic cholecystectomy (visual cholangiography): an additional step for prevention of CBD injuries. Surg Endosc 2000;14:88-9.
Rosemberg J, Leinskold T. Dome down laparosonic cholecystectomy. Scand J Surg 2004;93:48–51.
Honda G, Iwanaga T, Kurata M, Watanabe F, Satoh H, Iwasaki K. The critical view of safety in laparoscopic cholecystectomyis optimized by exposing the inner layer of the subserosallayer. J Hepatobiliary Pancreat Surg 2009;16:445–9.
Priego P, Ramiro C, Molina JM, Rodríguez Velasco G, Lobo E, Galindo J. Fresneda.Results of laparoscopic cholecystectomy in a third-level university hospital after 17 years of experience. Rev Esp Enferm Dig 2009;101(1):20–30.
Waage A, Nilsson M. Iatrogenic bile duct injury: a population-basedstudy of 152776 cholecystectomies in the Swedish inpatient registry. Arch Surg 2006;141:1207–13.
Karvonen J, Gullichsen R, Laine S, Salminen P, Grönroos JM. Bileduct injuries during laparoscopic cholecystectomy: primary andlong-term results from a single institution. Surg Endosc 2007;21:1069–73.
van der Steeg HJ, Alexander S, Houterman S, Slooter GD, Roumen RM. Risk factors for conversion during laparoscopiccholecystectomy: experiences from a general teachinghospital. Scand J Surg 2011;100:169–73.
Domínguez LC, Rivera A, Bermúdez C, Herrera W. Analysis of factors for conversion of laparoscopic to opencholecystectomy: a prospective study of 703 patientswith acute cholecystitis. Cir Esp 2011;89(5):300–6.
Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, et al. Preoperative findingspredict conversion from laparoscopic to open cholecystectomy. Surgery 2007;142(4):556–63.
Lima EC, Queiroz FL, Ladeira FN, Ferreira BM, Bueno JGP, Magalhães EA. Análise dos fatores implicados na conversão da colecistectomia laparoscópica. Rev Col Bras Cir 2007;34(5):321–5.
Chandio A, Timmons S, Majeed A, Twomey A, Aftab F. Factors Influencing the Successful Completion ofLaparoscopic Cholecystectomy. JSLS 2009;13:581–6.
Pavlidis TE, Marakis GN, Symeonidis N, Psarras K, Ballas K, Rafailidis S, et al. Considerations concerning laparoscopic cholecystectomyin the extremely elderly. J Laparoendosc Adv Surg Tech A 2008;18(1):56–60.
Ballal M, David G, Willmott S, Corless DJ, Deakin M, Slavin JP. Conversion after laparoscopic cholecystectomy in England. Surg Endosc 2009;23:2338–44.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.