LAPAROSCOPIC CHOLECYSTECTOMY: AN AUDIT OF 500 PATIENTS
AbstractBackground: The Gold standard treatment for symptomatic gallstone disease is laparoscopiccholecystectomy (LC) since 1990. LC can be performed safely as a day case procedure. Theobjective of this study was to evaluate the results of laparoscopic cholecystectomy in symptomatic gallstones disease in terms of length of hospital stay, complications, morbidity and mortality. Methods:This retrospective descriptive study was carried out in Department of General & Laparoscopic Surgery,AK CMH, Muzaffarabad. Notes of all patients who underwent laparoscopic cholecystectomy in thedepartment over a 26 month period were reviewed from department register. Demographics as well asdetails of cases, conversion to open operation and complications of surgery and anaesthesia werereviewed from clinical notes and departmental register and noted on a designed Performa. Data wereanalysed using SPSS-18 and results compared with international studies. Results: Out of 500 patients,443 (88.6%) were females and 57 (11.4%) were males. The mean age of the patients was 42.47±11.43years. Mean operative time was 40.09±11.16 minutes. Seven (1.4%) patients developed port site woundinfection. Sixteen (3.2%) cases were converted to open surgery in face of obscured anatomy of Calot’striangle. Two (0.4%) cases has cystic duct stoma leak secondary to missed Common duct stones andwere dealt with ERCP and stone extraction. There was no case of bile duct injury, major haemorrhageor bowel injury. There was no mortality associated with laparoscopic cholecystectomy in our series.Conclusion: Laparoscopic cholecystectomy is a safe and effective management of gall stone disease.Better training, careful case selection, meticulous technique and high standard equipment are ofparamount importance for ensuring good results in laparoscopic cholecystectomy.Keywords: Laparoscopic cholecystectomy, complications, cystic duct leak, bile duct injury, gall stone
Abbasi SA, Azami R, Haleem A, Tariq GR, Iqbal A,
Almas D, et al. An audit of laparoscopic cholecystectomies
performed at PNS Shifa. Pak Armed Forces Med J
McMahon AJ, Fischbacher CM, Frame SH, MacLeod MC.
Impact of laparoscopic cholecystectomy: a population-based
study. Lancet 2000;356:1632–7.
Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF,
McGuckin M, et al. Indications for and outcomes of
cholecystectomy: a comparison of the pre and postlaparoscopic
eras. Ann Surg 1998;227:343–50.
Targarona EM, Balague C, Knook MM. Laparoscopic surgery
and surgical infection. Br J Surg 2000;87:536–44.
Berggren U, Gordh T, Grama D, Haglund U, Rastad J, Arvidsson
D. Laparoscopic versus open cholecystectomy: hosptalization
sick leave, analgesia, and trauma responses. Br J Surg
Keulemans YCA, Eshuis J, Haesde H, Wit de LT, Gouma DJ.
Laparoscopic cholecystectomy: Day care versus clinical
observation. Ann Surg 1998;228:734–40.
Townsend CM Jr, Beauchamp RD, Evers M, et al, eds. Sabiston:
Tratado de Cirurgia. A base biológica da prática cirúrgica
moderna. 18ª ed. Philadelphia: Elsevier Saunders 2010;p. 1460.
Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS
Bittner R. Laparoscopic Surgery: 15 years after clinical
introduction. World J Surg 2006;30:1190–203.
Ros A, Gustafsson L, Krook H, Nordgren CE, Thorell A, Wallin
G, et al. Laparoscopic cholecystectomy versus mini-laparotomy
cholecystectomy: a prospective, randomized, single blinded
study. Ann Surg 2001;234:741–9.
Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ,
Campbell KA, et al. Surgical management of bile duct injuries
sustained during laparoscopic cholecystectomy: perioperative
results in 200 patients. Ann Surg 2005;241:786–92; discussion
Jacobi CA, Ordermann J, Zieren HU, Volk T. The impact of
laparoscopy with carbon dioxide versus helium on local and
systemic inflammation in an animal model of peritonitis. Surg
Zhang WJ, Li JM, Wu GZ, Luo KL, Dong ZT. Risk factors
affecting conversion in patients undergoing laparoscopic
cholecystectomy. Anz J Surg 2008;78:973–6.
Ballal M, David G, Willmott S, Corless DJ, Deakin M, Slavin JP.
Conversion after laparoscopic cholecystectomy in England. Surg
Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G,
Karayiannakis AJ. Risk factors for conversion of laparoscopic
cholecystectomy to open cholecystectomy. Surg Endosc
Botaitis S, Polychronidis A, Pitiakoudis M, Perente S,
Simopoulos C. Does gender affect laparoscopic
cholecystectomy? Surg Laparosc Endosc 2008;18:157–61.
Varela JE, Wilson SE, Nguyen NT. Laparoscopic surgery
significantly reduces surgical-site infections compared with open
surgery. Surg Endosc 2010;24(2):270–6.
Jablonska B, Lampe P. Iatrogenic bile duct injuries: etiology,
diagnosis and management. World J Gastroenterol
Csikesz N, Ricciardi R, Tseng JF, Shah SA. Current status of
surgical management of acute cholecystitis in the United States.
World J Surg 2008;32:2230–6.
Livingston EH, Rege RV. A nationwide study of conversion
from laparoscopic to open cholecystectomy. Am J Surg
Erol DD, Polat C, San O. The diagnosis and early treatment of
acute hemorrhagic shock after laparoscopic cholecystectomy.
Internet J Anaesthesiol 2005;9.
Schäfer M, Lauper M, Krähenbühl L. A nation’s experience of
bleeding complications during laparoscopy. Am J Surg
Hussain A, Mahmood H, Singhal T, Balakrishnan S, Nicholls J,
El-Hasani S. Long-term study of port-site incisional hernia after
laparoscopic procedures. JSLS 2009;13:346–9.
Lee JH, Kim W. Strangulated small bowel hernia through the
port site: A case report. World J Gastroenterol 2008;14:6881–3.
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.