LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS

The appropriate timing for laparoscopic cholecystectomy in the treatment of acute cholecystitis remains controversial. More recent evaluation indicates early laparoscopic surgery may be a safe option in acute cholecystitis, although conversion rates may be higher. 

No established protocol exists in this regards and the practice of doing interval cholecystectomy or immediate cholecystectomy is best left to the surgeons experience and discretion.

We in Ramayya Pramila Urology hospital prefer to do laparoscopic cholecystectomy in the treatment of acute cholecystitis.

A 60 year old gentleman - a bordeline diabetic presented with acute cholecystitis with fever.His LFT parameters were well preserved.We started the patient on Ertapenam and ornidazole for 48 hours and he was taken up for Laparoscopic cholecystectomy.

There was a lot of oedema and adhesions around the gall bladder.The calots triangle anatomy was not clear.The peritoneum over the gall bladder was thickened and the gall bladder was frable and oedematous.The gall bladder wall was torn during the surgery and frank pus drained out indicating the necessity of the surgery.The dissection was done in Calot's triangle after delineating the common bile duct anatomy and staying away from it.

After the gall bladder was disected away from the gall bladder fossa by blunt dissection ; the fossa and peritoneum was irrigated with copious amounts of normal saline irrigant.

The patient recovered well after the surgery.