The Better Surgical Option for Chronic Cholecystitits; Harmonic Scalpel or Conventional Laproscopic Cholecystectomy?

Abstract

ABSTRACT… Introduction: Laparoscopic cholecystectomy is a standard and widely used procedure in the treatment of chronic cholecystitis for quite a long time now but there is a recent development in technique because of advent of harmonic scalpel (HS). Thus this study was conducted with an objective to compare frequency of post-operative complications in patients undergoing laparoscopic cholecystectomy by conventional versus harmonic technique. Data Source: Primary data based on patients presenting with chronic cholecystitis to the surgical department at tertiary care hospital. Study Design: Randomized Control Trial. Study Setting:The study was conducted in surgical unit-I, Jinnah Hospital Lahore. Duration of Study: Study was conducted in duration of one year i.e. January 2015 to December 2015. Subjects & Methods: After approval from the hospital ethical review board, 400 patients of either sex with age from 16 to 60 years and a diagnosis of chronic cholecystitis were included using purposive non-probability sampling technique. They were then randomly assigned to either conventional or harmonic group for laparoscopic cholecystectomy using lottery method at a ratio 1:1. . Information regarding their demographic characteristics and frequency of gall bladder perforation during surgery along with readmission in patients was noted in a structured proforma and data was analyzed using SPSS version 21.0. Results: The mean age of patients was 48.19 ± 6.484 years with about 156 (39%) male patients while 244 patients (61%) were female. About 15 (7.5%) patients in harmonic group and 16 (8%) patients in conventional group of laparoscopic cholecystectomy had gall bladder perforation during the procedure while 20 (10%) patients of harmonic group and 27 (13.5%) patients in conventional group were readmitted. On application of chi square test it was seen that the differences were statistically insignificant in both groups for the complications related to the procedure. Conclusion: It can be concluded from this study that both treatments are equally effective in terms of gall bladder perforation and rate of readmission. Thus, any of the techniques can be selected without much fear of complications depending upon the health care facility and financial constraints of health system in a resource depleted developing country. Key words:Laparoscopic Cholecystectomy, Harmonic Scalpel, Gall Bladder Perforation, Electrocautry.