Outcomes of early versus interval laparoscopic cholecystectomy in acute calculus cholecystitis: A prospective analytical study
Anwarul Haque, Abu Sayem, Abu Bakar Siddique
Introduction: Gall stones are one of the major causes of morbidity and mortality all over the world. Cholecystectomy is the definitive treatment for patients with acute cholecystitis. Objective: To compare the outcomes of early versus interval laparoscopic cholecystectomy in acute calculus cholecystitis. Methods: A total of 50 patients were chosen for the study. They were selected on the bases of presence of two of the following four features: (1) Abdominal pain characteristic of Acute Cholecystitis, (2) Positive Murphy’s sign, (3) Total Leucocyte Count>10,000/ uL, and (4) Ultrasonographic evidence of Acute Calculus Cholecystitis. Study site: Islami Bank Medical College Hospital, Nowdapara, Rajshahi, Bangladesh. Patients with other complications of Cholecystitis, other abdominal pathologies and surgeries were excluded from the study. Patients were divided into 2 study groups by odd-even method of randomization and they were categorized as Group A and Group B alternatively as per their primary surgical OPD presentation sequence. Immediate cholecystectomy was performed in Group A patients while interval cholecystectomy after initial conservative management was done in Group B patients. Results: The mean age of presentation for acute calculus cholecystitis was found to be 48.4±14.2 years with36% of male patients and 64% of female patients of total patients. The Conversion of laparoscopic to open cholecystectomy rate was 8% in early cholecystectomy group as compared to 4% in interval cholecystectomy group in our study. The hospital stay was significantly longer in patients of interval cholecystectomy than early cholecystectomy. The intra operative and postoperative complications like bile and gall stone spillage due to gall bladder perforation, hemorrhage, biliary fistula and wound infection were more common with early than interval laparoscopic cholecystectomy. Complications like biliary fistulas occurred in patients operated for early cholecystectomy and not in interval cholecystectomy. The requirement of antibiotics and analgesics were significantly higher in interval cholecystectomy group as compared to early cholecystectomy group. No mortalities were recorded in either group. Conclusion: There is no significant difference in overall clinical outcome in patientsmanaged by immediate and interval cholecystectomy in case of acute calculus cholecystitis. The total hospital stay and medication requirement are higher in interval cholecystectomy group as compared to early cholecystectomy group.
Anwarul Haque, Abu Sayem, Abu Bakar Siddique. Outcomes of early versus interval laparoscopic cholecystectomy in acute calculus cholecystitis: A prospective analytical study. International Journal of Medical and Health Research, Volume 6, Issue 3, 2020, Pages 57-60