CHOLECYSTECTOMY IN THE ERA OF LAPAROSCOPE IN OUR HOSPITALS | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 22, Issue 3, July 2003, Page 242-248 PDF (142.74 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2003.374510 | ||||
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| Authors | ||||
| Ahmed Mohamed El-Morsy* ; Abdallah Saad El-sayed; Moussa Helmy Moussa; Khalid Fouad Khalifa; Mohamed Shafik Risk | ||||
| El-Mataria Teaching Hospital, El-Sahel Teaching Hospital, Ahmed Maher Teaching Hospital ,El-Mataria Teaching Hospital | ||||
| Abstract | ||||
| Background: In the early 1990s Laparoscopic cholecystectomy (LC) was practiced in many centers in our country. Laparoscopic cholecystectomy, an extension of short-incision cholecystectomy, with a completely new Concept into abdominal surgery, was Popularized by Dubois et al.(1), and Reddic and Olsen (2) - Tough, the procedure of LC was widely spreading, the Prospective audits reported a four fold to eight fold increase in biliary complications compared with those seen in open cholecystectomy (OC)(3-4). Whether this is related to the technique per se or is merely associated with a surgical learning curve has not been established. However , as the experience with this procedure accumulates, sporadic reports of non biliary complications, have been published(5). Objective: To assess the change in concept of cholecystectomy procedure and to determine outcomes, safety, frequency and obstacles of LC versus OC at multiple open staff hospitals with multiple surgeons. Patients and Methods: The clinical records of 572 patients who underwent cholecystectomies between January 2001 to December 2002 at author’s hospitals were re-evaluated with regard to history, physical examination, investigations, type of operation, grade of surgeon, length of incision, rate of conversion and its cause, operation time, concurrent procedures, postoperative analgesia, hospital stay and sick leave, over all complications and mortality. Results: Compared with LC, OC was more frequent 385/572 (67.3%) in whom short- incision cholecystectomy was 326/385 (84.7 %) predominate. LC performed in 187/572 (32.7 %) in whom conversion rate was 21/187(11%) and perforation of the gallbladder and spillage of gallstones into the peritoneal cavity occurred in 32/187 (17 %). Laparoscopic Cholecystectomy took significantly longer operative time (66 min verus 104 min) and less postoperative analgesic consumption in the first and second postoperative days. LC has no significant difference over OC in operative and postoperative complications apart from significant reduction in postoperative pulmonary complications (2.1 in LC vs 4.1 in OC) and wound infection (2.7 vs 3.8). Both techniques showed no significant difference in hospital stay, but sick leave is more longer for OC. Conclusion: This retrospective study showed that LC is the preferred procedure for elective cholecystectomy but its frequency is related to the availalbility of equipments and facilities. Short- incision OC was the practical choice, in case of unavailability of facilities for LC, and commonly performed as current surgical trainees are adept at this procedure. Conventional OC, “gold standard” , remains frequent and applicable to difficult or complicated cases and when additional procedure is required. | ||||
| Keywords | ||||
| Cholecystectomy; open cholecystectmy (OC); Laparoscopic cholecystomy (LC); Short- incision cholecystectomy | ||||
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