Acute Chole Waynad Final With Stats

8/13/2019 Acute Chole Waynad Final With Stats

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Does the timing of surgical intervention in

case of Acute cholecystitis alter the

Patient outcome ?

Dr. Aniz Ratani,

DNB Trainee Dept. Of General Surgery.

Dr. Sajeesh Sahadevan, Dr. Rajesh Nambiar,

Dr. Rohit Ravindran .

Department of Gastro Intestinal Surgery

Dr. Rojan Kuruvilla , Dr. Sajan P , Dr. Subhash VC .

Dept Of General Surgery.

Malabar Institute Of Medical Sciences,Kozhikode


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Introduction

Laparoscopic cholecystectomy (LC) is the gold standardtreatment

Optimal surgical timing is of major importance and still adebatable issue.

Delayed presentation frequently encountered in a largeurban hospital has therefore resulted in many surgeries

performed within the period of subacute inflammation.

Studies showed readmission of patients before intervalcholecystectomy either due to recurrent biliary colics orunderlying sepsis.


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Aims and Objectives

The objective of the study is to see whether the

timing of surgery in acute cholecystitis influencespatient outcomes in terms of morbidity, mortality

and duration of stay in the hospital.


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Sample Size and Population

The study was carried out in Malabar Institute of

Medical Sciences from the period of July 2012 to

December 2012, obtaining a sample size of 100.

The patients diagnosed to have Acute

Cholecystitis were divided into 3 groups.

Grp AOperated upon within 7 days of onset of

symptoms.

Grp BOperated between 8thday till 6 weeks.

Grp COperated after 6 weeks of duration.


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Material and Methods

Diagnosis.

Grouping.

Surgery performed with standard 4 ports.

Interim-Analysis


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Analysis and Results


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Population

< 7 days( A ), 50

8 to 6 weeks( B ) ,

39

> 6 weeks(C) ,

11

< 7 days( A )

8 to 6 weeks( B )

> 6 weeks(C)


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Mean Age Distribution

44.7 48.23

57.85

0

10

20

30

40

50

60

70

80

A B C

Age (in yrs )


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Males Vs Females

37

28

7

13

11

4

0

10

20

30

40

50

60

A B C

Females

Males


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Operative Period Time

0

50

100

150

AB

C

93.85

131.72

114.33

Time in minutes


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Significance

Group Mean Surgery time Range

A 93.85 35 - 165

B 131.72 75- 224

C 114.33 58 - 181

There is a significant difference in the surgery time

between groups. P value = 0.04 which is < 0.05.

So average surgery time is high in Group B than in

group A


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Adhesions

Fibrinous

Dense0

5

10

15

20

AB

C

9

17

0

0

86 Fibrinous

Dense


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Demographic and perioperative

Characteristics.Characteristic Group A Group B Group C

Male / Female 37 / 13 28 / 11 7 / 4

Age ( Median ) 44.70 48.23 57.85

Complicated

Cholecystitis

12 21 0

Spillage 3 9 0

Drain use 5 24 0

Operative time * 93.85 131.72 114.33

* p value < 0.05 , significant difference noted


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Conversion Rates and CBD injury

0

0.2

0.4

0.6

0.8

1

A B C

Conversion Rates

CBD injury

No significant difference was found between the three

groups in the parameters of conversion rates and CBD

injury.


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Complications

Complications Group A Group B Group C Total

Reoperation 0 0 0 0

Sepsis 0 3 0 3

Bile Leak 0 0 0 0

CBD injury 0 0 0 0

Wound infection 3 5 0 8

Paralytic Ileus 2 4 0 6

Others 1 1 0 2

Readmission * 0 0 0 0

Total 19

* till Jan 2013


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Average Length of Stay ( days )

0

1

2

3

4

5

6

7

A B C

4.57

6.17

5.19

Days

Days


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Significance

Group Mean length of stay ( in days ) Standard Deviation

A 4.57 1.66

B 6.17 3.28

C 5.19 1.83

There was a significant difference in the length of

stay between groups. P value = 0.008 < 0.05.

The average length of stay was found to be lower in

the Group A ( acute group )


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Conclusion

The best timing for a cholecystectomy inAcute cholecystitis was within 7 days after theinitial symptoms.

Safe cholecystectomy was possible even after7 days though the operating time and the

hospital stay was slightly more.

Timing of intervention did not increase themorbidity or the mortality.


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Thank You

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Acute Chole Waynad Final With Stats