The independent sample t test results t statistics 6. The sample size n is equal i. Table 2: Pain duration for both open and laparoscopic cholecystectomy groups are as follows. The mean post-operative hospital stay was 3.
Independent sample t test: t statistics Conversion of laparoscopic to open cholecystectomy occurred in three 3 of the fifty 50 patients i.
Two cases of laparoscopic cholecystectomy were converted to open surgery due to common bile duct injury and one due to intra operative hemorrhage. Rest of the laparoscopic cholecystectomies were uneventful. In open cholecystectomy group largest number of complications were due to wound infections Number 09 which significantly higher as compared with laparoscopic cholecystectomy No Postoperative ileus was present in 5 patients of open cholecystectomy group necessitated the need for continuation of nasogastric decompression.
Four patient from open group developed chest infection post operatively Table 3. In the history of surgery, very few operations have changed the thinking and operating habits of surgeons as quickly and on such broad scale as laparoscopic cholecystectomy.
This technique of small incision for cholecystectomy has shown good result in terms of reducing pain and morbidity and paved the way for use of minimal access surgery [ 9 , 10 ]. Laparoscopic cholecystectomy was first performed in Lyon, France in March by Philippe Mouret, a general surgeon, who already had vast experience in gynecological surgery and consequently was knowledgeable in the use of laparoscope.
The extent to which the surgical incision contributes to morbidity and mortality is well established. Sufficient time has elapsed since the first laparoscopic cholecystectomy was performed. Indeed explosive growth of minimally invasive surgery of which laparoscopic cholecystectomy is prototype mandates the need for comparisons with respect to morbidity and mortality. Most surgeons have passed through the learning curve phase of their experience and have now settled into established patterns of activity [ 11 , 12 ].
There has been lot of debate whether to operate asymptomatic gallstones or not. A century ago, in , Mayo wrote 'there is no innocent gallstone', but today we know there are plenty of evidences to support that not only there are asymptomatic gallstones but most of these incidentally found stones remain asymptomatic throughout life, and do not require treatment.
Several studies have shown that the natural history of incidentally discovered gallstone is not only benign but even when they do develop complications; it is usually preceded by at least one episode of biliary pain. In other words, the longer the stones remain asymptomatic, the less likely it is that complications will occur.
Thus, for persons with asymptomatic gallstones, the natural history is so benign that not only treatment but also a regular follow-up is not recornrnended [ 13 - 16 ].
Has laparoscopic cholecystectomy changed the view of the surgeons or physicians and the patients towards asymptomatic gallstones? Unfortunately, the answer is 'Yes'. Laparoscopic cholecystectomy in young patients with uncomplicated, asymptomatic gallstones is safe with greater patient acceptance, and this approach in early age eliminates the need for problematic surgery at a later date when the patient is older, with associated diseases or with complications [ 17 , 18 ].
The indications of surgery for asymptomatic gallstones are presence of diabetes, porcelain gall bladder and gallbladder with multiple stones and hemolytic anemia. It has been stated that diabetic patients are particularly prone to biliary complications from their stones.
This led some authors to advocate prophylactic cholecystectomy in asymptomatic diabetic patient. Sometimes consideration is given to perform an incidental cholecystectomy in addition to the planned operation in patients with asymptomatic gallstones. The purpose would be to prevent postoperative cholecystitis or the later development of symptoms.
Patients having multiple gallstones. The chance of slipping into CBD is high, as complications like obstructive jaundice, cholangitis and pancreatitis are likely [ 19 - 23 ]. The frequency of bile duct injury is 0.
Two most common reasons for conversion are dense upper abdominal adhesions or necrotic gall bladder wall that precludes grasping and elevation with grasper. Common risk factors for conversion are male gender, obesity, cholecystitis especially after 48 to 72 hours after onset of symptoms and choledocholithiasis. Most conversions happen after a simple inspection or a minimum dissection, and the decision to convert should be considered as a sign of surgical maturity rather than a failure.
Conversion should be opted for in the beginning and at the time of recognition of a difficult dissection rather than after the occurrence of complication. It is vital for the surgeons and patients to appreciate that the decision to go for conversion is not failure but rather implies safe approach and sound surgical judgment.
It is therefore mandatory to explain the patients about possibility of conversion to open technique at the time of taking consent for laparoscopic cholecystectomy [ 24 , 25 ]. In our study duration of operative time for laparoscopic cholecystectomy is considerably longer than duration of op24en cholecystectomy. This significant difference could be due to long learning curve for laparoscopic surgery. It is interesting to note that the indications for analgesia in both procedures were different.
Whereas in open cholecystectomy group this was due to wound pain, the patients in the laparoscopic group required post-operative analgesia for relief of shoulder tip pain secondary to diaphragmatic irritation due to CO2 pneumoperitoneum [ 26 , 27 ]. Wound infection in open procedure is 3 times the laparoscopic procedures. Jatzko et al. Barkun JS et al. Analyses were based on the intention-to-treat principle. Authors were requested additional information in case of missing data.
Sensitivity and subgroup analyses were performed when appropriate. Thirty-eight trials randomised patients. Most of the trials had high bias risk. Meta-analysis of all trials suggests less overall complications in the laparoscopic group, but the high-quality trials show no significant difference 'allocation concealment' high-quality trials risk difference, random effects Authors' conclusions:. Search strategy:. Selection criteria:. However no definitive data on its use in AC has been published.
Material and methods: A systematic-review with meta-analysis and meta-regression of trials comparing open vs. Results: Ten trials have been included with a total of patients: in the LC and into the OC groups. The post-operative wound infection and pneumonia rates were reduced by LC OR 0.
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