Page 26 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic Cholecystectomy in Gangrenous Cholecystitis

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Preetinder Brar , Iqbal Singh , Hemant Yadav , Saraansh Bansal , Jai Dev Wig 5
Received on: 18 March 2022; Accepted on: 20 May 2023; Published on: 05 September 2023
AbstrAct
Introduction: Gangrenous cholecystitis (GC) is difficult to diagnose preoperatively. A delay in diagnosis leads to increased complications. A high
index of suspicion followed by early surgery leads to increased chances of laparoscopic cholecystectomy with decreased morbidity and early
discharge. The aim of the study was to study the demographics, contrast-enhanced computerized tomography (CECT) and magnetic resonance
imaging (MRI) findings, type of procedure (laparoscopic/open), and the outcome of the patients.
Materials and methods: A retrospective study was undertaken on GC patients. Patients were divided into three groups depending upon the
type of surgery (LC, OC, LC-OC). Patient demographics, comorbidities, preoperative biochemical, CECT, MRI findings, time taken from admission
to surgery, type of surgery, post-op complications, and length of stay were compared.
Results: During a 5-year period, a total of 55 patients were diagnosed with GC. Of these cases, 47.27% underwent laparoscopic cholecystectomy
(LC), 41.82% were treated with OC, and the remaining 10.91% had a combination of LC and OC. The median age of the patients was 58.12 ± 16.66
years, 65.65 ± 11.13, 58.16 ± 12.79 years in LC, OC, LC-OC groups respectively. The male to female ratio was 1.4:1. Approximately 45.45% of the
individuals had hypertension, while 41.81% were diagnosed with diabetes. Additionally, 16.36% of the patients were found to have coronary
artery disease (CAD), and 14.54% were undergoing antiplatelet therapy. Moreover, leukocytosis was observed in 40% of the patient cases. The
conversion rate from laparoscopic procedure to open procedure was 18.75%. Postoperative morbidity was seen in 18.18% of patients. Average
hospital and ICU stay in the LC group was the shortest (3.76 ± 1.94 days, 0.53 ± 1.38 days respectively). Hospital and ICU stay in the OC group
was 10.8 ± 5.76 and 2.43 ± 5.35 days respectively. The average stay of the LC-OC group in the hospital and ICU was 9 ± 6.75 and 3.5 ± CECT 68
days. The p-value for hospital and ICU stay was 0.0001 and 0.0179 respectively.
Conclusion: A high index of suspicion, and increased use of CECT and MRI in suspected cases followed by early LC leads to favorable outcomes
in GC.
Keywords: Cholecystitis, Gangrenous, Laparoscopic.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1562

IntroductIon 1 Department of Surgery, Gian Sagar Hospital & Medical College,
Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis Rajpura, Punjab, India
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(AC). It results from increasing vascular insufficiency resulting 2,5 Department of Surgery, Fortis Hospital, Mohali, Punjab, India
in mural infarction, necrosis, and perforation of the gall bladder 3 Department of Surgery, Pushpanjali Hospital & Research Centre,
(GB). 2,3 Treatment of GC is challenging due to difficulty in Rewari, Haryana, India
preoperative diagnosis, increased intraoperative complications, and 4 Department of Thoracic Surgery, National Institute of Tuberculosis
more morbidity and mortality postoperatively. 1,4,5 Early preoperative and Respiratory Diseases, New Delhi, India
diagnosis of GC is essential to reduce delays in surgery. Preoperative Corresponding Author: Preetinder Brar, Department of Surgery,
evaluation of GC requires cross-sectional imaging techniques like Gian Sagar Hospital & Medical College, Rajpura, Punjab, India, Phone:
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computed tomography and magnetic resonance. Management of +91 8146931208, e-mail: drpreetinder.brar@yahoo.com
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GC is similar to AC, i.e., laparoscopic cholecystectomy (LC). Early LC How to cite this article: Brar P, Singh I, Yadav H, et al. Laparoscopic
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in GC can decrease the incidence of complications. The threshold Cholecystectomy in Gangrenous Cholecystitis. World J Lap Surg
for conversion to open surgery should be kept low in patients with 2023;16(1):25–28.
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GC. Conversion rates in GC are higher varying from 14 to 35% Source of support: Nil
compared to non-GC AC (3.4–7%). 4,11,12 In our study, we reviewed Conflict of interest: None
the records of patients with GC. Demographics, radiological and
histopathological findings, and postoperative complications of
the patients with GC were noted. The time taken from admission examination were included. The study was approved by the
to surgery and hospital and intensive care unit (ICU) stay of patients institutional ethics committee. The study population was divided
who underwent LC, OC, and LC-OC were compared.
into three groups based on the type of surgical procedure, i.e.,
laparoscopic cholecystectomy (LC), open cholecystectomy
MAterIAls And Methods (OC), and laparoscopic cholecystectomy converted to open
This retrospective observational study was conducted in Fortis cholecystectomy (LC-OC). For each patient medical record was
Hospital, Mohali from 2010 to 2015 after necessary approvals from analyzed for the demographics (age, gender), preexisting
the Institutional Ethics Committee. We reviewed data of patients comorbidities [hypertension (HT), diabetes mellitus (DM), coronary
who underwent cholecystectomy for cholecystitis in the above artery disease (CAD)], etc., preoperative manifestations (upper
period. Patients who were diagnosed with GC on histopathology abdomen pain, vomiting, and fever), preoperative laboratory

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