A study of laparoscopic cholecystectomy in rural setup
DOI:
https://doi.org/10.18203/2349-2902.isj20183732Keywords:
Cholelithiasis, Cholecystectomy, Cholecystitis, LaparoscopicAbstract
Background: Cholelithiasis is one of the major healthcare problems faced by the adult population all over the world. The disease prevalence is ever increasing because of the changing lifestyles and dietary habits. With emergence of laparoscopic cholecystectomy, it has become standard treatment modality for all kind of patients of gall stone disease. But still in India laparoscopic procedures are not routinely carried out in rural setup. So, we have decided to carry out this prospective study of laparoscopic cholecystectomy in rural setup mainly emphasizing on the cost benefit aspect and its impact on economical aspect of the rural government hospital as well as the patient’s financial burden.
Methods: In this prospective randomized study, 60 patients of symptomatic cholelithiasis were grouped into open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) groups randomly (30 each). The preoperative, intra operative and postoperative findings were noted and compared with each other and also with previous studies. The results are compared using paired t test and chi square test.
Results: Laparoscopic cholecystectomy was better than open cholecystectomy in terms of less analgesic requirement, postoperative hospital stay, surgical site infection with better cosmetic outcome. The results were comparable regarding intra operative complications. Only duration of surgery was comparatively more in laparoscopic group. Thus, overall laparoscopic cholecystectomy was cost effective alternative as compared to open cholecystectomy.
Conclusions: Laparoscopic cholecystectomy is better alternative to open cholecystectomy in term of less intra and postoperative complications as well as decreased financial burden on public health sector and patient point of view.
References
Margret O, Pham TH, Hunter JG. Gallbladder and the extrahepatic biliary system. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al. Editors. Schwartz’s Principles of Surgery. 9th edition. New Delhi. The McGraw-Hill Companies, Inc; 2010:1135-66.
Chari RS, Shah SA. Biliary System. In: Townsend CM, Beauchamp RD, Evers BM and Mattox KL. Editors. Sabiston Textbook of Surgery. 18th Ed. Noida (U.P.), Elsevier Inc.; 2008;2:1547-88.
Morgernstern L. Carl langenbuch and the first cholecystectomy. Surgical Endoscop. 1992;6(3):113-4.
Gallstones and Laparoscopic Cholecystectomy. NIH Consens Statement Online. 1992;10(3):1-20.
Kelley JE, Burrus RG, Burns RP, Graham LD, Chandler KE. Safety, efficacy, cost and morbidity of laparoscopic versus open cholecystectomy: a prospective analysis of 228 consecutive patients. Am Surg. 1993;59(1):23-7.
Attwood SE, Hill AD, Mealy K, Stephens RB. A prospective comparison of laparoscopic cholecystectomy versus open cholecystectomy. Ann R Coll Surg Engl. 1992;74(6):397-400.
Talpur KA, Laghari AA, Yousfani SA, Malik AM, Memon AI, Khan SA. Anatomical variations and congenital anomalies of extra hepatic biliary system encountered during laparoscopic cholecystectomy. J Pak Med Assoc. 2010;60(2):89-93.
Ghnnam W, Malek J, Shebl E, Elbeshry T, Ibrahim A. Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia. Ann Saudi Med. 2010;30(2):145-8.
Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic versus open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg. 1998;133(2):173-5.
Rooh-ul-Muqim, Qutab-e-Alam J, Zarin M, Aurangzaib M, Wazir A. Complications of laparoscopic cholecystectomy. World J Laparoscopic Surg. 2008;1(1):1-5.
Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, et al. Laparoscopic cholecystectomy: incidents and complications: a retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford). 2003;5(3):152-8.
Buanes T, Mjaland O. Complications in laparoscopic and open cholecystectomy: a prospective comparative trial. Surg Laparosc Endosc. 1996;6(4):266-72.
Bosch F, Wehrman U, Saeger HD, Kirch W. Laparoscopic or open conventional cholecystectomy: clinical and economic considerations. Eur J Surg. 2002;168(5):270-7.
Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L. Randomized clinical trial of open versus laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2005;92:44-9.
Hardy KJ, Miller H, Fletcher DR, Jones RM, Shulkes A, McNeil JJ. An evaluation of laparoscopic versus open cholecystectomy. Med J. 1994;160(2):58-62.
Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg Laparosc Endosc. 1997;7(5):407-14.
Koperna T, Kisser M, Schulz F. Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterol. 1999;46(26):753-7.
Al Hadi FH, Chiedozi LC, Salem MM, George TV, Desouky M, Pasha SM. Comparison of laparoscopic and open cholecystectomy at Prince Abdulrahman Al Sudairy Hospital; Saudi Arabia. East Afr Med J. 1998;75(9):536-9.
Trondsen E, Riertsen O, Anderson OK, Kjaersgaard P. Laparoscopic and open cholecystectomy: A prospective randomized study. Eur J Surg. 1993;159(4):217-21.
El-Morsy AM, El-sayed AS, Moussa MH, Khalifa KF, Shafik M. Risk, cholecystectomy in the era of laparoscope in our hospitals. Egyptian J Surg. 2003;22(3).
Capizzi FD, Fogli L, Brulatti M, Boschi S, Di Domenico M, Papa V, et al. Conversion rate in Laparoscopic cholecystectomy: evolution from 1993 and current state. J Laparoendosc Adv Surg Tech. 2003;13(2):89-91.
Grace PA, Quereshi A, Coleman J, Keane R, McEntee G, Broe P, et al. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg. 1991;78:160-2.
Chan HS, Ha XF, Ooi PJ, Mack P. A prospective comparative study between conventional and laparoscopic cholecystectomy. Singapore Med J. 1995;36(4):406-9.
Porte RJ, De Vries BC. Laparoscopic versus open cholecystectomy: a prospective matched- cohort study. HPB Surg. 1996;9(2):71-5.
Schietroma M, Carlei F, Liakos C, Rossi M, Carloni A, Enang GN, et al. Laparoscopic versus open cholecystectomy: An analysis of clinical and financial aspects. Panminerva Med. 2001;43(4):239-42.
Kum CK, Wong CW, Goh PM, Ti TK. Comparative study of pain level and analgesic requirement after laparoscopic and open cholecystectomy. Surg Laparosc Endosc. 1994;4(2):139-41.
Berggren U, Gordh T, Grama D, Haglund U, Rastad J, Arvidsson D. Laparoscopic versus open cholecystectomy: hospitalization, sick leave, analgesia and trauma responses. Br J Surg. 1994;81:1362-5.
Hendolin HI, Paakonen ME, Alhava EM, Tarvainen R, Kempinen T, Lahtinen P. Laparoscopic or open cholecystectomy: a prospective randomized trial to compare postoperative pain, pulmonary function and stress response. Eur J Surg 2000;166(5):394-9.