Abstract

Early versus Delayed Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis in Southern Odisha - A Prospective Comparative Study

Author(s): Manoj Kumar Sethy1, M. Siva Rama Krishna2, S. Jagannath Subudhi3, Biswa Ranjan Pattanaik4, Manita Tamang5, Ambuja Satapathy6, P. Narmada Reddy7

BACKGROUND
Acute cholecystitis is a pathology of inflammatory origin, usually associated with
cholelithiasis, with a high incidence in the world. Its treatment involves an
important socioeconomic impact. There are two surgical therapeutic options: early
laparoscopic cholecystectomy (ELC) done within 72 hours of onset of pain or
delayed laparoscopic cholecystectomy (DLC) done after 6 weeks of conservative
treatment. The present study intends to compare between the effectiveness of
ELC vs DLC in the management of acute cholecystitis in a tertiary care setup.
METHODS
The study sample included 65 patients who were clearly documented and
radiologically proven cases of acute calculous cholecystitis, met the inclusion
criteria, admitted to the surgery department of MKCG MCH, Berhampur, between
August 2018 and July 2020. Out of 65 patients, 33 and 32 patients were selected
randomly for ELC and DLC respectively. In ELC group surgery was done within 72
hours of the onset of pain while in DLC group surgery was done after 6 weeks of
initial conservative treatment. The study was conducted using a case record
proforma, prepared in their local language. The questionnaire included timing of
cholecystectomy, duration of antibiotic coverage, mean duration of hospital stay,
number of intraoperative and postoperative complications, conversion to open
cholecystectomy, and follow-up. The data was compiled and tabulated in MS ®
Excel and statistically analysed using IBM ® SPSS 22.0.
RESULTS
The overall morbidity and mortality were less in ELC compared to DLC. The mean
duration of surgery was less in ELC (47.36 minutes) compared to DLC (65.75
minutes). The mean duration of antibiotic coverage was lesser in ELC (3.58 days)
compared to DLC (5.50 days).The mean hospital stay was less in ELC (4.67 days)
to DLC (6.50 days). The overall morbidity and mortality were less in ELC.
CONCLUSIONS
ELC is considered to be a safe modality of treatment in patients with acute
cholecystitis and leads to an economical treatment.