PREDICTIVE FACTORS FOR SUCCESSFUL EARLY LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY
Dr. Ahmed Al Amin*, Dr. AKM Daud, Dr. Monoranjon Sarker, Dr. Syeda Ishrar Islam, Dr. Tanzir Hussain, Dr. Syeda Nadia Islam Juee
Background: Laparoscopic management of acute cholecystitis may still be associated with increased risk of complications and the conversion rate to open cholecystectomy is accordingly higher when compared to elective cases. Objective: To find out the predictive factors for successful early laparoscopic cholecystectomy in acute cholecystitis. Methods: It was a prospective randomized study conducted in the dept. department of surgery, Jalalabad Ragib-Rabeya Medical College and Hospital, Sylhet from June 2018 to May 2019. Patients of acute cholecystitis being operated within 5 days of onset of symptoms was included in the study. Sixty five acute cholecystitis patients were included. Clinical information’s acute cholecystitis being operated within 5 days of onset of symptoms were collected by the questionnaire according to the protocol and relevant investigations were done. Collected data in each group were compared and coded by statistical analysis. Results: Fifty one (78.5%) patients were successful completion of early laparoscopic cholecystectomy and 14(21.5%) were conversion of early laparoscopic cholecystectomy. Forty three (84.3%) patients were female in successful group and 7(50.0%) in conversion group. Male patients had significantly higher conversion rate which was 7(50%) the difference was statistically significant (p<0.05) between two groups. The mean serum CRP was found 2.7±0.8 mg/dl in successful group and 5.2±1.4 mg/dl in conversion group. The mean duration of surgery was found 62.7±12.1 minute in successful group and 80.1±13.9 minute in conversion group. The mean duration of hospital stay was found 2.4±0.5 days in successful group and 5.7±1.3 days in conversion group. Which were statistically significant (p<0.05) between two groups. Thirty one 31(60.8%) patients were found intraoperative severity grade Ib in successful group and 1(7.1%) in conversion group. The difference was statistically significant (p<0.05) between two groups. Conclusion: More than two third patients were successful completion of early laparoscopic cholecystectomy. Male patients with acute cholecystitis and serum C-reactive protein level was > 2.7 mg/dl at admission had significantly higher conversion rate. Duration of surgery and mean duration of hospital stay were found significantly higher in conversion group.
Keywords: Cholecystitis, laparoscopic, gallbladder, cholangitis, pancreatitis.
[Full Text Article]