Efficacy of Early Versus Delayed Laparoscopic Cholecystectomy in Federal Government Services Hospital Islamabad

Abstract

Background: Acute cholecystitis is a commonest surgical issue and was mostly treated via conservative management followed by the delayed laparoscopic cholecystectomy after interval of the 6 to 8 weeks. However, by the increasing experience in the laparoscopies, surgeons started to attempt early laparoscopic cholecystectomy for acute cholecystitis. Objective: To compare the efficacy of early and delayed laparoscopic cholecystectomy in the acute phase in terms of the conversion to open cholecystectomy. Study Design: Randomized Clinical Trial. Settings: General Surgery Department of Federal Govt. Services Polyclinic Hospital, Islamabad-Pakistan. Duration: Two years from June 2014 to May 2016. Methodology: Patients with established acute cholecystitis diagnosis with age 20 to 50 years and either of gender were included. In early laparoscopic cholecystectomy; removal of gall bladder was done laparoscopically within 72 hours of onset of inflammation and in delayed procedure after 6 weeks of conservative administration. Outcome was assessed via conversion to open cholecystectomy. All the data was recorded in the self-made proforma. Results: Total 196 patients were compared for efficacy of early and delayed laparoscopic cholecystectomy. 41 to 50 years was the most common age group among both groups. Conversion to open cholecystectomy was 5.1% in early group and 6.1% was in delayed group (p-0.711). Efficacy was statistically insignificant according to age and gender p-values were quite insignificant. Conclusion: Early laparoscopic cholecystectomy showed good efficacy with lower conversion rate to open cholecystectomy and additional advantages of safety form extra uses of antibiotics and painkillers of conservative treatment duration.