Early Laproscopic Cholecystectomy as a Fruitful Tool For Acute Cholecystitis in The Patients of Lower Socioeconomic Domain

Dr.Salesh kumar soni; Dr.S.P. Chouhan; Dr.Kedar nath

Volume : III, Issue : X, October - 2014

Early Laproscopic Cholecystectomy as a Fruitful Tool For Acute Cholecystitis in The Patients of Lower Socioeconomic Domain

Dr. Salesh Kumar Soni, Dr. S. P. Chouhan, Dr. Kedar Nath

Abstract :

Cholecystectomy in acute attack has been a subject of debate in recent past due to fear of increased morbidity. The need of early lap. Cholecystectomy in acute cholecystitis becomes more obvious particularly in the patients of lower socioeconomic domain, as once they are treated conservatively for acute attack they do not return till another attack or any complication develops. If gall bladder can be removed in acute attack these complications as well as major burden on the health care system can be reduced.The Aims and Objectives of the study was to compare the outcome of early vs delayed cholecystectomy in acute cholecystitis and to assess the feasibility of Laparoscopic cholecystectomy as a preferential method over open cholecystectomy particularly in the patients of lower socioeconomic domain. The study was done in 104 patients of lower socioeconomic status(class 5 of b.kuppuswamy 1971) between 2010 – 2013. Two groups were made. Patients of early group were operated early with in 96 hrs of onset of symptomes in same hospitalization, half by open and half by laparoscopic method. While patients of delayed surgery group were first managed conservatively and then operated after 6 weeks as interval cholecystectomy, half by open and half by laparoscopic method.There was no significant difference in operative time (71.55min. early vs 67.54min. delayed) and post operative complication ,with open cholecystectomy taking more time than lap. Cholecystectomy in both the group. There was a significant increase in the post op. hospital stay of 1.50 days (5.24days early vs 3.74 days delayed) in early surgery group, But the total mean hospital stay of early surgery group was significantly lower(7.34days early vs 11.32 delayed). Dropout rate of patients who didn�t come for interval cholecystectomy on advised time was 46%. Most of these patients came back with another attack or some other complication. Average total cost of treatment was 32% less in early group. Conversion rate from open to lap was a little higher in early group(7.6% early vs 3.8% delayed) probably because relaxing criteria of early cholecystectomy from 72 hrs to 96 hrs. we concluded that whenever possible early surgical intervention should be tried in patients of lower socioeconomic domain suffering from AC, even up to 96 hrs after onset of symptoms . It gives the advantage of less overall hospital stay, less overall economical burden to the patient, reduces the work load of health care system, reduces the chances of recurrent episodes of cholecystitis and other gallstone related complications. LC is a safe, valid alternative to OC in these patients , providing all the advantages of minimal invasive surgery .