Page 20 - WJOLS

Rooh-ul-Muqim et al

wound infections and duration of hospital stay in patients and they were converted to open cholecystectomy. Of these 2
undergoing LC and OC. patients had severely distorted anatomy of the Calot’s triangle
making dissection impossible, and in 2 cases there was iatrogenic
MATERIALS AND METHODS injury to the cystic artery and cystic duct (1 case each).
Thirty-one patients had laparoscopic cholecystectomy, out
This study was conducted in Surgical D Unit Khyber Teaching of which 7 (25.9%) patients had a 1 day postoperative hospital
Hospital, Peshawar from July 2006 to December 2006. One stay, 14 patients (45.16%) stayed 2 days in the hospital, 7 (25.9%)
hundred two symptomatic cases of gallstone disease presented had a 3 days hospital stay, 2 (7.4%) had 4 days stay, and only 1
to the unit in these 6 months out of which 50 cases were included (3.7%) had a 5 days stay in the hospital (this patient had a slight
in the study as the rest did not fit into the inclusion criteria and biliary leak which stopped by itself by the 5th postoperative
were thus excluded. Inclusion criteria was: (1) Patients with day). The mean hospital stay in these patients thus came out to
symptomatic gallstone disease only, (2) Patients with normal or be 2.06 days. The patients who underwent open surgery had a
near normal BMI (up to 10 kg over the ideal BMI was considered 2-day hospital stay in only 1 patient (6.66%), 4 patients (26.6%)
near normal), (3) Non-pregnant. Exclusion criteria included: stayed 3 days in the hospital, 6 (40%) had a stay of 4 days, and
(a) Past history of surgery especially in the upper abdomen, 3 (20%) had a hospital stay of 5 days. Only 1 patient stayed for
(b) Diabetes mellitus or any other co-morbid condition, e.g. 6 days in the hospital (6.66%). The mean in this group came out
hypertension, CAD/IHD, peripheral vascular disease, chronic to be 3.93 days of postoperative hospital stay, which is
lung condition, etc. which may hamper postoperative progress, significantly higher than the laparoscopy group. The 4 cases
(c) Patients using oral contraceptives, steroids or any other converted to open from laparoscopic form showed variable
medication which may have a bearing on the postoperative lengths of hospital stay, i.e. 1 had a 5 day stay, 7 days in two
recovery. and 25 days in one patient. Mean stay came out at 11.25 days in
Patients admitted both as emergency and OPD were included this group. Only the patient who had iatrogenic injury to the
and their clinical data was obtained on pre-formed proformas. cystic duct had a prolonged hospital stay of 25 days and even
Their date of admission, date of surgery and the surgical she was discharged on the 6th postoperative day, but she
procedure they underwent were noted. All operations were returned a day later with biliary leak from wound site and had to
performed by senior consultant surgeons or senior residents be re-admitted. Except this, all the rest had uneventful
under supervision. Postoperatively the patients were followed postoperative recoveries with no complications.
for their requirement of analgesia, time of mobilization, tolerance
of oral feeds, signs of infection (e.g. fever, chest infection, Postoperative Morbidity
wound infection) and their date of discharge from hospital was
also recorded. The patients were followed for upto 4 weeks for The other parameters of postoperative progress that we
any complications. From this data mean hospital stay, frequency considered also showed a clear advantage of LC over OC. Pain
of analgesic requirement, chest infection, febrile morbidity, was significantly lower in the LC group with 18 patients (58.06%)
mobilization and discharge with return to activity were calculated having mild pain, 12 (38.7%) having moderate pain and only
to compare the difference between the two groups. Most 1 case (3.22%) complaining of severe pain requiring analgesia
important parameter that was closely followed was wound for 2 days. Severe pain requiring prolonged analgesia was seen
infection in the two groups. Wound infection was graded as in 3 cases (15.7%) of OC, 14 (73.68%) having moderate pain and
follows: 2 (10.5%) having mild pain. Fever was noted in 5 cases of OC
1. Grade I: skin and superficial subcutaneous tissue infection (26.31%) as against only 1 case (3.22%) of LC. Wound infection
only requiring wound dressing. was not seen in any patients with LC and 11 cases (57.8%) of
2. Grade II: Deep subcutaneous tissue infection requiring OC, whereas 2 cases (10.5%) of OC showed grade 1 infection
antibiotics, drainage of pus and dressings with prolonged and 1 case each (5.2%) of grade 2 and 3 infections were seen. 4
hospital stay. cases of OC (21%) and 2 cases (6.45%) showed mild chest
3. Grade III: Widespread infection or systemic infection infection. Mild GIT disturbances (nausea, vomiting, etc.) were
requiring hospitalization and I/V antibiotics. seen in all patients in the immediate postoperative period and in
no case later than 6 hours post-op. 3 patients (15.7%) with OC
had prolonged vomiting and required I/V anti-emetics.
RESULTS
Hospital Stay DISCUSSION

Out of the 50 patients who were included in the study, 15(30%) Gallstones are a major cause of surgical morbidity as well as
5
patients underwent open surgery, 31(62%) had laparoscopic admissions. The estimated prevalence of GS disease in Pakistan
6
cholecystectomy and 4(8%) patients were those in which an is 15% and may be responsible for 22% admissions in a surgical
attempt at laparoscopic cholecystectomy was made which failed unit. 7
18