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J Liaquat Uni Med Health Sci. 2008; 7(1): 18-24


Laparoscopic Cholecystectomy in Complicated Gallstone Disease

Abdul Aziz Laghari, K. Altaf Hussain Talpur, Arshad Mahmood Malik, Sangrasi Ahmed Khan and Amir Iqbal Memon.

Abstract
OBJECTIVE: To assess the role of laparoscopic cholecystectomy (LC) in gallstone disease with
its complicated problems.
DESIGN: Prospective observational study.
SETTING: Surgical Department of Liaquat University of Medical & Health Sciences, Jamshoro
and Private Hospitals of Hyderabad, Sindh-Pakistan; from May 2001 to April 2005.
METHODS: The patients were categorized as cases of complicated gallstone disease on the basis
of clinical assessment, investigations especially ultrasound abdomen and operative findings
noted during laparoscopic cholecystectomy. All patients were explained for advantages and
disadvantages of early LC with their difficult disease problem and willing taken for study. Sampling
strategy was convenient. The patients with uncomplicated gallstones, obstructive jaundice,
acute pancreatitis and carcinoma of gall bladder were excluded from this series.
RESULTS: 120 out of 400 patients presented with one of the known complication of cholelithiasis
such as chronic cholecystitis 50%, acute cholecystitis 12.5%, empyma 18.33%, mucocele
10% and fibrosed gall bladder in 9.17% of cases as assessed on clinical examination, ultrasound
and laparoscopic findings. Majority (75%) of cases were having adhesions around gall
bladder and 25% without adhesions. Problems encountered during LC were difficult separation
of tight adhesions around gallbladder (50.0%), grasping and holding of thick walled and distended
gallbladder (41.67%), dissection and identification of structures in Calotís triangle
(29.17%), haemorrhage from main cystic artery and gall bladder bed 20.83% and delivery of
large and thick wall gallbladder in 25% of cases. Intra operative complications seen during procedure
were haemorrhage in 20.83% cases, perforation of gallbladder by instrumentation in
12.5% and avulsion of cyctic duct in 1.67% of cases. Two patients (1.67%) were converted to
open cholecystectomy due to bleeding. Postoperatively 12.5% of patients developed biliary
leak, out of which 3 cases (2.5%) were due to actual common bile duct injury, 2.5% of cases developed
port-site sepsis as main postoperative complications. Cases with bile duct injury were
re-explored and managed accordingly. Hospital stay varied from 2-7 days but majority of patients
were discharged (70.83%), within 2-3 days, no mortality was seen in this series.
CONCLUSION: Laparoscopic cholecystectomy like uncomplicated biliary stone disease is
equally effective procedure for complicated cholelithiasis. Its applicability is almost 95% in experienced
hands.

Key words: Gall stones. Complications. Laparoscopic cholecystectomy. Operative problems. Conversion rate.



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