A Study on Advantages of Laparoscopic Cholecystectomy over Open Cholecystectomy

Résumé

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of the digestive tract. It has replaced open cholecystectomy as the gold standard treatment for cholelithiasis and inflammation of the gallbladder. The procedure offers the patient reduced hospital stay, faster return to work, less pain, and improved cosmetic results. This study aimed to analyze the advantage of laparoscopic cholecystectomy over open cholecystectomy. Methods: This prospective study was conducted at the Department of Surgery, Naogaon Medical College, Naogaon, Bangladesh, from July 2015 to June 2017. A total of 100 patients were selected for this study purpose as per inclusion criteria. Statistical analysis of the results was obtained by using Statistical Packages for Social Sciences (SPSS-17) software. Result: In this study, most (30, 30. 0%) of the patients belonged to the age group of 31-40 years, followed by 27 patients (27. 0%) in the group of 41-50 years, 25 patients (25. 0%) in the group of 20-30 years and the rest 18 patients (18. 0%) in the group of 51-60 years of age. The present series showed female predominance for indications of cholecystectomy. Out of 100 study subjects 50 (50. 0%) patients underwent the laparoscopic procedure and 50 (50. 0%) patients underwent the laparotomic procedure. Regarding intra-operative findings, most (26, 26. 0%) of the patients had short cystic duct, followed by empyema in 21 (21. 0%) patients, 17 (17.0%) patients had intrahepatic gallbladder, 15 (15. 0%) patients experienced mucocele, 12 (12. 0%) patients had contracted gallbladder, and the rest 9 (9. 0%) patients had bilobed gallbladder. Concerning complications, most (8, 16. 0%) of the patients suffered from bleeding in the laparotomy group while 3 (6. 0%) patients suffered from bleeding in the laparoscopy group and were managed by laparoscopic control-laparotomy, followed by 6 (12. 0%) patients experienced surgical site infection in laparotomy group though only 1 (2. 0%) in the laparoscopy group and were managed by percutaneous drainage, 4 (8. 0%) patients had a hernia in laparotomy group while 2 (4. 0%) patients had a hernia in the laparoscopy group and hernia was repaired, 5 (10. 0%) patients experienced bile leakage in laparotomy group and 2 (4. 0%) in the laparoscopy group and were managed by laparotomy-ERCP. However, 2 (4. 0%) patients went through choledochal injury in the laparoscopy group and 1 (2. 0%) in the laparotomy group. In terms of prior abdominal surgery, 18% of patients went through the previous abdominal laparoscopic procedure and 20% underwent a laparotomic procedure. Regarding the comparison of laparoscopy and laparotomy procedure, hospital stay was also less (1-2 days) in laparoscopy and more (≥3 days) in laparotomy, duration of operation was shorter (20-30min) in laparotomy and comparatively longer (30-60 min) in laparoscopy. Recovery to normal activity was early in laparoscopy and late in laparotomy. Conclusion:This study concluded that in individuals with acute cholecystitis, laparoscopic cholecystectomy is a legitimate, safe alternative to open cholecystectomy. In comparison to open cholecystectomy, the procedure has a lower risk of problems, suggests a shorter hospital stay, and provides a more comfortable postoperative phase for the patient.