LAPAROSCOPIC CHOLECYSTECTOMY AT RAWALPINDI GENERAL HOSPITAL – A CLINICAL PRACTICE AUDIT

Abstract

Laparoscopic cholecystectomy has been the procedure of choice for the treatment of calculous cholecystitis for over a decade now. In order to evaluate the practices at our own surgical settings, a prospective, clinical practice audit of laparoscopic cholecystectomy was carried out. We described the operating time, duration of hospital stay, frequency of conversion to open cholecystectomy and frequency of intra- and post-operative complications, among 1000 patients undergoing laparoscopic cholecystectomy at Surgical Unit-I, Rawalpindi General Hospital and at the author’s Surgical Clinics from January 1998 to December 2007.
Results: There were 883 females and 117 males. Mean age was 45.0 ± 11.0 years. 66.6% patients had chronic cholecystitis with cholelithiasis and were admitted through Out Patient Department whereas 33.4% were admitted through Accident and Emergency Department with acute cholecystitis. Abdominal ultrasound showed multiple calculi in 745 (74.5%) patients and 255 (25.5%) patients had single calculus preoperatively. Empyema was found in 60(6%) cases whereas adhesions were present in 403(40.3%) patients. In our study conversion rate was 4.8% and frequency of injury to common bile duct was 1.4%. Mean operating time was 40 minutes. 92.0% of the patients were discharged within 48 hrs of operation. In our study, there was no mortality while post-operative complications were seen in 6% patients.
Conclusion: Laparoscopic Cholecystectomy in our set up proved to be a safe procedure (post-operative complications 6%), having short duration of surgery(mean 40 min) and short hospital stay(92.0% being discharged in less than 2 days).