Saravana Kumar, S (2010) A comparative study between open and Laparoscopic cholecystectomy in gallstone disease. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: Gastro-intestinal surgery has undergone a revolution in the recent years by the introduction of laparoscopic techniques. The concept of “keyhole surgery” created an immediate disparity between the potential of the new technique and training of surgeons to perform it. Now modern surgical methods are aimed at giving cure along with minimal invasive techniques with patient in mind, safety never being compromised. Cholelithiasis, which continues to be one of the most common digestive disorders encountered, was traditionally being dealt by conventional or open cholecystectomy. With the introduction of laparoscopic cholecystectomy, the surgical community witnessed a revolution in basic ideology and the importance of minimal access surgery. Laparoscopic cholecystectomy (LC) has become so safe and easy that it can be performed with much ease and safety because of better magnification. Although LC has shown clear benefits in terms of shortened hospital stay, less morbidity, mortality, a quicker return to work and with cosmetic advantage, many questions regarding this procedure remain unanswered, particularly relative to the gold standard procedure of open cholecystectomy. Some surgeons have suggested that the rates of serious complications, particularly bile duct injury might be significantly higher in laparoscopic procedures resulting in major morbidity and even mortality. Apart from the high costs of the equipment and the specialized training that is mandatory for mastery of the technique, the procedure inherently carries hazards and risks. In a developing country like ours, where the medical costs and loss of working days constitute major issues, could laparoscopic cholecystectomy establish itself as a safe and cost effective alternative to the open method? In our study, we have made an attempt to compare the advantages and drawbacks of both the procedures in an Indian set up. AIMS AND OBJECTIVES: The aim of this study is to compare conventional cholecystectomy and laparoscopic cholecystectomy with respect to: 1. Duration of the procedure, 2. Post operative discomfort or pain, 3. Analgesic requirement, 4. Complications encountered, 5. Diet, 6. Period of hospitalization, 7. Return to normal activity. MATERIAL AND METHODS: The study subjects consisted of 81 patients with a diagnosis of calculous cholecystitis that underwent cholecystectomy at Tirunelveli Medical College Hospital, Tirunelveli-11 from July 2007 to December 2009. The patients were interviewed for detailed clinical history according to a definite proforma. All the patients were examined and underwent routine blood investigations with LFT wherever necessary. Abdominal USG was performed in all the cases. Inclusion Criteria: Patients with cholelithiasis proven by USG with at least one attack of upper abdominal pain and considered fit for elective cholecystectomy were included in the study. Exclusion Criteria: The patients with following conditions were excluded from the study: • History or investigations suggesting CBD stones. • Patient’s underwent surgery for acute cholecystitis • Patient’s who underwent surgery for complications like empyema gall bladder, perforation gall bladder. RESULTS: This study was conducted during a two and half year period from July 2007 to December 2009, a total of 81 cases of Cholecystectomy were studied. Of these, 49 patients underwent laparoscopic Cholecystectomy and 15 patients underwent open type and 5 patients had to be converted to open type. CONCLUSIONS: Laparoscopic cholecystectomy is a considerable advancement in the treatment of gall bladder disease. The advantages of laparoscopic cholecystectomy are several: • Technically, the dissection of the cystic artery and cystic duct is very precise and bleeding is easily controlled with less peri operative blood loss. • LC is associated with less chances of wound infection and there is no risk of wound dehiscence. • The antibiotic usage in LC is comparatively lesser than that of OC. • The degree of post operative pain and its duration is less. • The amount of analgesic requirement is less in LC. • LC patients tolerate oral feeds earlier and are mobilized faster. • The duration of hospital stay is less and patients can be discharged quickly from the hospital. • Patients of LC group can resume their work earlier. • The cosmetic advantage in LC is obvious. Cholecystectomy remains a common operation. Laparoscopic management of symptomatic gallstones has rapidly become the new standard for therapy throughout the world. Many patients can now undergo this operation in an ambulatory setting. There are numerous advantages of LC over OC. However, occasionally anatomical or physiological considerations will preclude the minimal access approach, and conversion to an open operation in such cases reflects sound judgment and should not be considered a complication
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | open and Laparoscopic cholecystectomy, gallstone disease, comparative study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 09 Jun 2018 17:26 |
| Last Modified: | 13 Jan 2020 14:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8356 |
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