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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109

Volume 16, Issue 1, Aug 2015 pp 143-147

Research Article

Outcome analysis of early laparoscopic cholecystectomy in acute cholecystitisthrough various grades using Tokyo guidelines grades

Habeeb Mohammed Shajahan1, Natarajan Ramalingam2, Balakrishnan Varadharajan3, Karunanithi Ramaiah3, Loganathan Mannu1

1Associate Professor, 3Professor, 2Assistant Professor, Department of Surgery, Chettinad Hospital and Research Institute, IT Highway, Kelambakkam, Kancheepuram District, Tamil Nadu, INDIA 603103.

Background: Many randomised trials and meta-analysis across the globe have consistently provided evidence to support the importance of early Laparoscopic Cholecystectomy in patients with Acute Cholecystitis. Yet, the practise is not adopted evenly among General surgeons. We started our practise of early laparoscopic intervention for such cases in 2010, initially for early Cholecystitis, gradually moved on to intervene laparoscopically for severe forms of Cholecystitis by the year 2014. The Tokyo guidelines was first published in 2007, later bettered with minor modifications and updated in 2013 as TG13. The purpose of this descriptive study is to analyse the outcome of our practise retrospectively by stratifying our patients using Tokyo Guidelines into various grades and to check if our outcome in all grades are consistent with various universally published results in literature. Methods: Data from the patients who underwent Early Laparoscopic Cholecystectomy between 2012 and June 2015, were analysed. Various factors considered for assessing the effectiveness and safety of the procedure was, conversion rate, operating time, length of hospital stay, incidence of major complication and mortality. Data were compared between various grades of Cholecystitis as stratified by Tokyo guidelines 2013 (TG13). Results: Out of 137 patients who underwent an initial Laparoscopic approach, the overall conversion rate was 10.2%. (Grade I – 2.6%, Grade II – 16.7%, Grade III – 26.3%, P<0.01). The overall average operating time was 65 minutes (Grade I – 56 minutes, Grade II – 72 minutes, Grade III – 99 minutes). The average length of hospitalisation was 5.6 days (Grade I – 4.5 days, Grade II – 5.5 days, Grade III – 9.9 days). The incidence of major complication is 1.4% (2 cases of bile duct injury), both occurring in Grade III group. There was no incidence of mortality. Conclusion: Our analyses have shown that the results were comparable with literature and that Early Laparoscopic Cholecystectomy is the safe and effective approach for patients with Acute Cholecystitis.