Management of Inflamed Gall bladders Irrespective of Time line- A Prospective Study

Abstract

Introduction: Usually laparoscopic cholecystectomy is performed in symptomatic cholelithiasis as an elective procedure and is considered as a gold standard. The role of laparoscopic cholecystectomy in early stage of acute cholecystitis i.e.within 72 hours of onset of symptomsin terms of feasibility,efficacy and safety is well proved beyond doubt with secondary advantages of early recovery,shorter hospital stay,no associated complications of acute cholecystitis in waiting period,early return to work, overall beneficial for the patient and is noncontroversial now. As for as late laparoscopic cholecystectomyi.e.after 72 hours to 6 weeks is concerned, there is a lack of consensus among surgeonsbut there are certain studies in literature which clearly shows that late laparoscopic cholecystectomy is safe and feasible with all advantages of ELC if it is performed by experienced surgeons. Eventhough it is said that the severity of inflammation increases with the time but it is not always true as response to inflammatory process varies in each individual because of unique quintessence of inheritance and hence time is no more a barrier in performing late laparoscopic cholecystectomy provided surgeon is experienced and skilled in modified techniques used in the management of difficult gallbladders with frozen calot. Methods: In our study of 104 patients the intraoperative findings are almost similar in both groups irrespective of stage of acute cholecystitis and timeline.There were difficult GB with frozen calot in both group,these all were managed by intraluminal guided retrograde dissection technique with the principle that no anatomical structure passes through the lumen of GB. Results: There is no difference in surgical outcome in early vs late laparoscopic cholecystectomy in terms of safety and efficacy, even though in late phase it is technically difficult and more time consuming, needing special skill and experience and use of special modified techniques.Both groups were comparable in terms of morbidity, mortality and hospital stayindependent of time line. Conclusion: Laparoscopic cholecystectomy for acute cholecystitis during emergency admission is safe and associated with low morbidity and low conversion rate regardless of time limit.