EARLY CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: EXPERIENCE AT DHQ HOSPITAL ABBOTTABAD

Authors

  • Asif Saeed
  • Muhammad Nawaz
  • Aysha Noreen
  • Sarfraz Ahmad

Abstract

Background: Cholelithiasis is a common disorder affecting the females more commonly. Most of thepopulation carrying the gallstones remains asymptomatic, however biliary colic and acute cholecystitisis a common complication. Most surgeons agree that early cholecystectomy is safe and should be theprocedure of choice in acute cholecystitis. Objective of this study was to determine the frequency ofpatients with acute cholecystitis, and morbidity and mortality in such cases. Methods: A prospectivestudy, conducted at DHQ Hospital Abbottabad, and Yahya Welfare Hospital, Haripur simultaneouslyon 162 patients having symptomatic gall stones. All patients were admitted on presentation and surgicalintervention done within 72 hours on patients fit for surgery. Patients with cardiac problem, HCVpositive, and with radiologic evidence of Common Bile Duct (CBD) stones were excluded.Ultrasonography abdomen was the main investigation. Results: Postoperative complications, hospitalstay and return to routine activities was evaluated. The postoperative complications were seromaformation in 3 cases (1.9%), liver trauma resulting in bleeding and prolonged hospital stay in 1 case(0.6%). In 1 patient stones slipped into CBD resulting in CBD exploration. Conclusions: Earlycholecystectomy with upper right transverse incision and muscle retraction in acute cholecystitis is asafe, and cost effective procedure with fewer complications, better cosmesis and early return to work.Keywords: Gall stones, Cholecystitis, Bile leakage, CBD stones, Cholecystectomy

References

Russell RCG, The gallbladder and bile ducts. In: Russell RCG,

Williams NS and Bulstrode CJK. Bailey and Love’s Short

Practice of Surgery 24th Edition Arnold International Students

Edition London; 2004. p.1103–6.

J Ayub Med Coll Abbottabad 2010;22(3)

http://www.ayubmed.edu.pk/JAMC/PAST/22-3/Asif.pdf

Doherty GM, Way LW. Biliary Tract. In: Doherty GM. Current

Surgical Diagnosis and Treatment. 12th Edition. Lange Medical

Books/McCran Hill 2006. p. 582–4.

Garner JP, Sood SK, Robinson J, Barber W, Ravi K. The cost of

ignoring Acute cholecystectomy. Ann R Coll Surg Engl

;91(1):39–42.

Al-Mulhim AA. Timing of early laparoscopic cholecystectomy

for acute cholecystitis. JSLS 2008;123):282–7.

Morgan M, Paul E, Devlin HB. Length of stay for common

surgical procedures. variation among districts. Br J Surg

;740:884–9.

Azra A Ghani, Waqar Alam Jan, Aminul Haq. Acute

cholecystitis: Immediate versus interval cholecystectomy J

Postgrad Med Inst 2005;19(2);192–5

Perissat J, Coket D, Belliard R. Gallstones: Laparorscopic

treatment--cholecystectomy, cholecystostomy and lithotripsy; our

own technique. Surg Endosc 1990;4(1):1–5.

Finlagson N. Cholecystectomy for gallstones. A good thing if

they cause symptoms. Br Med J 1989;289:132–3.

Bailey RW, Zucker KA, Flower JL, Scovill WA, Graham SM,

Imbembo AL. Laparoscopic cholecystectomy: experience with

consective patients. Ann Surg 1991;214:531–40.

Sackmann M, Delius M, Sauerbruch T, Chanj CH, Nauheimsk,

Aucar JA, et al. Shock wave lithotripsy of gall stones; The first

patients. N Engl J Med 1988;318;393–7.

Thistle JL, May GR, Bender CF, Richardson JD, Miller FB,

Spain DA, et al. Dissolution of cholesterol gall bladder stones by

methyl ter-butyl ether administered by percutaneous transhepatic

catheter. N Engl J Med 1989;320:633–9.

Tameem MA. Mini laparotomy cholecystectomy splitting versus

partial and whole transaction of the rectus abdominis muscle.

Saudi Medical J 1995;2:113–5.

Renato AG, Gustavo R. Minimally Invasive Open

cholecystectomy. Am J Surg 1998;18:566–74.

Maingot R. Abdominal operations. 7th Ed. Vol 1. New York:

Appelton Century-Crofts; 1980. p.1033–55.

Nasrullah Khan, Abid Haleem, Ijaz Ahmed, Attaullah Jan.

Cholecystectomy through mini laparotomy incision. Gomal J

Med Sci 2009;7(2):92‒5.

Khan FM, Samad A, Aman Z. Mini cholecystectomy through

-CM incision: Influence on morbidity and hospital stay. J

Posgraduate Med Institute 1995;9(2):53‒9.

Melzack R, Abbott FV, Zackon W, Mulder DS, Davis MW. Pain

on a surgical ward: Survey of the duration and intensity of pain

and effectiveness of medication. Pain 1987;29:67–72.

Luman W, Adams WH, Nixon SN, Mcintyre IM, Hamer-Hodges

D, Wilson G, et al. Incidence of persistent symptoms after

laproscopic cholecystectomy: prospective study, Gut

;39(6):863‒6.

Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ.

Laparoscopic versus open cholecystectomy for patients with

symptomatic cholecystolithiasis. Cochrane Database Syst Rev

;(4):CD006231.

Downloads

Published

2010-09-01