Clinical Outcome of Early Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis in Comparision to Laparoscopic Cholecystectomy in Chronic Cholecystitis at a Tertiary Hospital

Abstract

Background: The standard management of ACC is; initial control of inflammation and pain by bowel rest, intravenous hydration, parentral antibiotics and analgesics followed by interval cholecystectomy after 6-8 weeks. Now a days, laparoscopic cholecystectomy (LC) is the gold standard surgical modality for the management of gall stones disease. LC in ACC was considered to be difficult due to adhesions and oedema thereby resulting in higher risk of complications and conversion rate. On the other hand, during the waiting period for definitive surgery, there is an increased risk of recurrent episodes of acute cholecystitis and other serious complications due to gall stones. Recent studies have shown that in experienced hands and proper patient selection, LC is feasible and safe definitive management option in ACC. This study was designed to evaluate the outcome of LC in patients of ACC. Aims: • To evaluate the feasibility of laparoscopic cholecystectomy in acute calculus cholecystitis. • To compare the outcome with laparoscopic cholecystectomy in chronic calculus cholecystitis. Materials and Methods: The study included 30 patients (group A) of gall stone disease admitted with acute cholecystitis in surgery emergency department of Government Medical College & Hospital, Chandigarh and the outcome of LC in this group was compared with the outcome of LC in control group of (group B) 30 cases of gall stone disease having chronic cholecystitis fulfilling the inclusion criteria during the study period. Results: Majority of patients were in 5th and 6th decade of life and the female to male ratio was 3.5:1. Most common presentation was pain and tenderness in right hypochondrium. Duration of acute attack was, 12 hours in 2(6.6%) patients, 24 hours in 12(40%) patients, 48 hours in 9(30%) patients, 60 hours in 3(10%) patients, 72 hours in 2(6.6%) patients. In 25(83.3%) patients surgery performed within 24-48 hours, in 5(16.6%) surgery performed within 49-72 hours .The temperature was> 37.50 C in 20(66.6%) patients. Leukocytosis was >11000/mm3 in 4(13.3%) patients. The serum CRP was >5 mg/dl in all of the patients (100%) of ACC. Mean duration of surgery was 33.87±19.70 minutes in group A and 38.87±29.07 minutes in group B. LC was successful in 26(86.6%) patients in both the group. The mean VAS score at 6 hour, 24 hours and on discharge were 3.96±2.06, 1.57±0.94 and 0.34±0.48 in group A and in group B 3.65±1.87, 1.92±1.46 and 0.65±0.79 respectively. The requirement of analgesia in no. of dosages were 3.53± 2.83 in group A and 4.67± 2.77 in group B with statistically significant difference (p value 0.013). Surgical site infection was seen in 2(6.6%) patients of each group, where the laparoscopic cholecystectomy was converted to open surgery. Mean duration of post-operative stay was 1.5 days in group A and 2.3 days in group B. The mean expenditure in group A was 834.615±380.465 Rs. of patients admitted in general ward and in group B was 919±441.831 Rs. Histopathology showed acute inflammation in 24(80%) patients (first stage), xanthogranulomatous changes in 1(3.3%) patient (second stage) and fibrosing  cholecystitis in 5(16.6%) patients of ACC. Conclusion:After proper patient selection, in experienced hands early LC in ACC within 96 hours of acute attack is feasible and safe along with additional medical and socioeconomic advantages.