Laparoscopic Cholecystectomy in Empyema Gall Bladder - Its Safety and Feasibility.

Abstract

Objective: To study the clinical profile of Empyema Gall Bladder and to assess the feasibility of laparoscopic cholecystectomy in such cases. This prospective clinical study covers 69 cases of empyema of the gall bladder, which were admitted in the Department of General Surgery At Institute of Medical Sciences and SUM Hospital ,Bhubaneswar,Odisha,India during the period from January 2015 to December 2016. All the Cases were planned for elective laparoscopic cholecystectomy. Results: In our series which included 69 patients ranging from age group of 22 years to 68 years,maximum incidence between 40 -60 years .The male female ratio being 1: 2.13.All the cases were attempted laparoscopically out of which 66(95.6%) were successfully completed while only 3 (4.3%) were converted to open due to completed frozen calots anatomy in 2 cases while cholecystoenteric fistulas in 1 case .The mean operating time was 80 minutes. Varied operative difficulties such as bleeding, obscure Calot's anatomy, Perforated/gangrenous Gall bladder were meticulously managed. Post-operative complications were seen in 20(28.9%) patients out of which port site infection (n = 11) was the most notable while others like bile leak was seen in only 5 patients. Maximum number of patients (n=49 )were discharged within 48-96 hours with only 6 patients requiring a stay beyond 1 week. We cocluded thatLaparoscopic Cholecystectomy can be very well performed in cases with Empyema Gall Bladder with the view in mind about increased risk of intra as well as post -operative complications. Impervious patience, meticulous dissection, clarity in anatomy and the experienceof the surgeon though may play key roles in decreased conversion rates and complications.