Comparative Study between Early and Late Laparoscopic Cholecystectomy in the Treatment of Acute Cholecystitis

Background: Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic gallbladder stone. The common opinion about the treatment of acute cholecystitis (AC) is initially conservative treatment due to preventing complications of inflammation and following delayed laparoscopic cholecystectomy after 6–8 weeks. However, with the increase of laparoscopic experience in recent years, early LC has become more common. Methods: This study included 40 patients of AC with comparison between early (20 patients) and delayed (20 patients) LC. In AC, initial conservative treatment was given and early LC performed within 72 hours and delayed LC was done after 6–8 weeks, both groups monitored since admission, during operations, and along the postoperative (PO) period. Results: There was a significant difference in the successful LC conversion rates out of 20 each (20 early versus 19 delayed, pvalue= 0.000), and conversion, open cholecystectomy (OC) to delay cholecystectomy conversion rates 5% or complication was found in delayed out of 20 in adhesion was 20%, wound Infection 1% and pain 15%; hospital stay was more significant in delayed LC 0.007 and USG finding in compared between early and delayed, was more common in delayed LC. Conclusion: Intraoperative and PO complications being associated more with delayed LC as compared to early LC, so early LC should be preferred for treatment of AC. Key-words: Acute cholecystitis, Early laparoscopic cholecystectomy, Delayed laparoscopic cholecystectomy, Open cholecystectomy INTRODUCTION The prevalence of cholesterol gallstones is increased in obese people. The risk is particularly high in those with a higher weight record. Weight reduction further builds the danger of gallstones. Around 33% of the stones are symptomatic. The expanded predominance of stones is generally because of super-saturation of bile with cholesterol, due to increased synthesis by the liver and emission into bile. Saturation is additionally increased during weight reduction . LC is a method of choice in the management of calculus gallbladder disease in the general population. How to cite this article Yadav GD, Kumar M. Comparative Study between Early and Late Laparoscopic Cholecystectomy in the Treatment of Acute Cholecystitis. SSR Inst. Int. J. Life Sci., 2020; 6(3): 2588-2593. Access this article online https://iijls.com/ Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstone disease. The significant points of interest of LC incorporate less PO pain, less time required for hospitalization and recovery and better cosmetic results. The general view in the treatment of AC is to firstly administer conservative therapy to prevent possible complications associated with inflammation and afterwards following 6 to about 8 weeks, to perform LC. Although over 70% of such patients respond to clinical treatment within the initial 24 to 48 hours . The benefits of this minimally invasive technique over open surgery are less PO pain, earlier mobilization; less pulmonary function impairment, decreased operative stress, and a shorter hospital stay [ . Be that as it may, the ideal timing of cholecystectomy in patients with AC stays disputable. The refreshed Tokyo Guidelines propose that an early laparoscopic cholecystectomy (ELC) is compulsory for patients with mild cholecystitis, Research Article SSR Inst. Int. J. Life Sci. ISSN (O): 2581-8740 | ISSN (P): 2581-8732 Yadav and Kumar, 2020 DOI: 10.21276/SSR-IIJLS.2020. 6.3. 8 Copyright © 2015–2020| SSR-IIJLS by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 06 | Issue 03 | Page 2589 whereas delayed laparoscopic cholecystectomy (DLC) can be performed in patients with moderate or severe cholecystitis . The customary treatment (introductory) of acute calculus cholecystitis incorporates bowel rest, intravenous hydration, and normalization of electrolyte abnormalities, analgesia, and intravenous antibiotics [7-10]. As this strategy, requested a tremendous involvement with LC, the number of specialists performing early LC for AC in India is little inferable from the late presentation of methodology in our nation. Till now, the specific planning and potential advantages of early laparoscopic removal of gall bladder have not been settled and keep on being questionable . Anyway, with the increase of laparoscopic involvement with ongoing years, early LC has gotten increasingly more common. MATERIALS AND METHODS The study was based on case-control and conducted in the Department of General Surgery, Associate LLRM Hospitals, GSVM Medical College, Kanpur, India from January 2018 to October 2019 on patients, who were admitted from casualty and outpatients department with a diagnosis of AC. Inclusion criteria  Age group >15–70 years  Symptomatic gallstone disease (SGBS) o Biliary colic pain o Acute cholecystitis Exclusion criteria  Age below 15 or above 70 years  Not willing to participate  Severe concomitant disease  Suspected Common Bile Duct stone  Asymptomatic gall stone disease  Acalculous cholecystitis Selection of Early and Late laparoscopic cholecystectomyEvaluation of these patients would be based on patient’s characteristics, comprehensive study, hematological and radiological parameter, these patients would be taken for LC. Those patients, who were not fit or not willing for LC would be undergone OC. The patients, who presented with AC was divided into two groups on alternate basis patients of one group go for early surgery within 72 hours onset of symptoms and the other group was managed conservatively and was undergone LC after 6 weeks. The comparison was done between operative parameters of both the groups. Operative parameters (a) Assess to peritoneal cavity: Access will be also designated as easy or difficult. (b) Gall bladder dimension: GB will be either designated as contracted, normal or distended (as in mucocele or empyema). (c) Calot’s triangle anatomy: Calot’s triangle anatomy will be designated normal, variable or obscure. (d) Calots triangle adhesions: Adhesions would be mentioned either present or absent. (e) Calot’s triangle dissection: will be designated as easy or difficult. (f) Dissection of gall bladder from bed: Designated as easy or difficult. (g) Spillage of bile and stones: Designated as yes or no. (h) Duration of Surgery: Duration of surgery will be defined as the time taken from the first incision to the closure of the last port. (i) Conversion to open: Conversion to open will be designated as yes or no and cause of conversion was mentioned. Statistical AnalysisThe results are presented in mean±SD, percentage and chi square test. Percentage of test was used to compare the categorical variables between present or absent complication. The pvalue<0.05 was considered significant. All the analysis was carried out by using SPSS 21.0 version (Chicago, Inc., USA). RESULTS Demographic findingsAs depicted in Table 1, the study groups, which underwent early or delayed laparoscopic cholecystectomy, showed no difference in age and sex distribution. Initial clinical findings and medical history were also similar between groups, except for the fever, which was significantly higher in the delayed to early LC group (54.77±10.57 versus 43.2±2.76; p=0.0001) respectively. SSR Inst. Int. J. Life Sci. ISSN (O): 2581-8740 | ISSN (P): 2581-8732 Yadav and Kumar, 2020 DOI: 10.21276/SSR-IIJLS.2020. 6.3. 8 Copyright © 2015–2020| SSR-IIJLS by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 06 | Issue 03 | Page 2590 Table 1: Demographic data of patients in the early and delayed LC groups Variables Early LC (n=20) Delayed LC (n=20) p-Value Age 30.5±7.52 40.12±13.04 0.006 Sex (%) Male 0(0) 2(10) >0.05 Female 20(100) 18(90) Hospital stay 2.4±0.50 2.7±0.82 0.1705 Pain duration (h) 1.85±0.366 1.8±0.383 0.6753 Operation time 43.2±2.76 54.77±10.57 0.0001 The complication rate, conversion to early laparoscopic cholecystectomy and duration of surgery showed no significant differences between early and late laparoscopic cholecystectomy except for jaundice no complications for the early and delayed LC group (Table 2). Table 2: Complications early and delayed LC groups Complains Early (n=20) Delayed (n=20) Right Hypochondrial Pain Present 20 (100%) 3(15%) Absent 0(0%) 17(85%)