DOI: http://dx.doi.org/10.18203/2349-2902.isj20212774

Assessment of immediate postoperative complications in patients undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis with pre-existing co-morbid conditions

Jainendra K. Arora, Deepak Kumar

Abstract


Background: Elective laparoscopic cholecystectomy done by experienced surgeon continues to be a vary safe operation however from surgical point of view, presence of co-existing clinical conditions offer independent complication risk but the influence of these clinical conditions such , diabetes, hypertension, respiratory etc. has not been emphasized enough. This study is an effort to determine the influence of co-existing clinical conditions on morbidity and mortality following laparoscopic cholecystectomy.

Methods: This prospective observational study was conducted over a period of 1.8 years from August 2017 to April 2019. On the basis of selection criteria patients with symptomatic cholelithiasis were divided into two groups cases and control group. The evaluation of morbidity was done in terms of any wound infection, chest infection, cardiac complications, cholangitis, deep vein thrombosis, septicemia, etc.

Results: Distribution of complications was comparable between cases and controls. (Nil: 90% versus 92.50% respectively. Proportion of patients with complications was significantly lower in patients without history of previous attack as compared to with history of previous attack. Distribution of complications were comparable between diabetic and non-diabetic.

Conclusions: The presence of co- morbid conditions in the form of diabetes mellitus and hypertension does not in-crease the risk of immediate post operative complications. However, history of previous attack of acute cholecystitis can increased chances of intra-operative adhesions around calots triangle prolonging the duration of surgery which in turn can increase the risk of post operative complications.


Keywords


Coexistent conditions, Outcome of laparoscopic cholecystectomy, Diabetes and laparoscopic cholecystectomy

Full Text:

PDF

References


Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am. 2010;39(2):157-69.

Dhanke PS, Uganda SP. Factors predicting difficult laparoscopic cholecystectomy: A single institution experience. Int J stud Res. 2014;4:3-7.

Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, et al. Mortality and complications associated with laparoscopic cholecystectomy. A meta analysis. Ann Surg. 1996;224(5):609-20.

Turrill FL, Mc Carron MM, Mikkelsen WP. Gall stone and diabetes melllitus: an ominous association. The American Journal of Surgery. 1961;102(2):184-90.

Haff KC, Butcher H Jr., Ballinger WF. Factors influencing morbidity in biliary tract operations. Surg. Gynecol obstet. 1971;132(2):195-203.

Olokobe AB, Bojuwoye BJ, Olokoba LB, Brainmoh KT, Inikori. Gallstone disease and type 2diabetes mellitus - the link. J Coll Physicians Surg Pak. 2007;17:594-7.

Stinton LM, Eldon A. Shaffer.Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer. Gut Liver. 2012;6(2):172-87.

American diabetes association. Executive summary: Standard of medical care in diabetes-2011. Diabetes care 2011;34:S4-10.

World health organisation. Definition and diagnosis of Diabetes Mellitus and intermediate hyperglycaemia: Report of WHO/IDF Consultation. Geneva: World Health Organization. 2006. Available at: https://www.who.int/diabetes. Accessed on 3 March 2021.

Moser M. World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension-Do These Differ From the U.S. Recommendations? Which Guidelines Should the Practicing Physician Follow? J Clin Hypertens (Greenwich). 1999;1(1):48-54.

Novacek G. Gender and gallstone disease. Wien Med Wochenschr. 2006;156(19-20):527-33.

AL Mulhim AR. The outcome of laparoscopic cholecystectomy in diabetic patients: a prospective study. J Lapa-roendosc Adv Surg Tech A. 2010;20(5): 417-20.

den Hoed PT, Boelhouwer RU, Veen HF, Hop WC, Bruining HA. Infections and bacteriological data after laparo-scopic and open gallbladder surgery. J Hosp Infect. 1998;39(1):27-37.

Chen X, Luo D, Li S, Mao J, Zhou Z, Yu S, Duan Z. Experience in prevention of serious complications of laparo-scopic cholecystectomy. Chin Med J (Engl). 1996;109(3):223-7.

Nassar AHM, Hodson J, Ng HJ. Predicting the difficult laparoscopic cholecystectomy: develop-ment and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc. 2020;34:4549-61.6:191