BackgroundLaparoscopic Cholecystectomy (LC) is the gold standard for the treatment of cholelithiasis in most countries of the world. The objective of this study was to evaluate the outcomes of LC in the surgery department of Cure International Hospital, Kabul, Afghanistan. MethodsA retrospective study was conducted on 1430 LC cases performed by the general surgery department of Cure International hospital. Data was collected from patient files and the operation theatre registry for whom LC was performed during January 2008 through December, 2019. ResultsMean age was 45.77±13.45 years (14-90 years), with male/female ratio of 1:4.7. One third (33%) had comorbidities. Most of patients (~97%) were classified as ASA grade I and II. Of all patients, 26.8% of males and 13.2% of females had gallbladder inflammation (OR=2.203, 95%CI 1.56 – 2.61, P=0.000). Overall mean duration of anesthesia was 75±25.6 minutes. The conversion rate to OC was 4.6% (N=66), most commonly dense adhesions at Callot’s triangle (3.8%). The intraoperative complication rate was 17.5% (N=249), where bile/stone spillage was the most common indication (N=235, 16.4%). Immediate postoperative complication rate was 2.4% (N=35). Average length of stay (ALOS) after LC was 2.23±1.43 days (1-19 days).ConclusionThis study shows that elective LC can be performed safely in Afghanistan with comparable outcomes in terms of complications, conversion rates, and ALOS to other countries of the region and the world. Proper case selection and careful preoperative evaluation and management can decrease further conversion, intra- and postoperative complications.

Background Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of cholelithiasis in most countries of the world. The objective of this study was to evaluate the outcomes of LC in the surgery department of Cure International Hospital, Kabul, Afghanistan. Methods A retrospective study was conducted on 1430 LC cases performed by the general surgery department of Cure International Hospital. Data was collected from patient files and the operation theatre registry for whom LC was performed during January 2008 through December, 2019. Results Mean age was 45.77 ± 13.45 years (14–90 years), with male/female ratio of 1:4.7. One third (33%) had comorbidities. Most of patients (~ 97%) were classified as ASA grade I and II. Of all patients, 26.8% of males and 13.2% of females had gallbladder inflammation (OR = 2.203, 95% CI 1.56–2.61, P = 0.000). Overall mean duration of anesthesia was 75 ± 25.6 min. The conversion rate to OC was 4.6% (N = 66), most commonly dense adhesions at Callot’s triangle (3.8%). The intraoperative complication rate was 17.5% (N = 249), where bile/stone spillage was the most common indication (N = 235, 16.4%). Immediate postoperative complication rate was 2.4% (N = 35). Average length of stay (ALOS) after LC was 2.23 ± 1.43 days (1–19 days). Conclusion This study shows that elective LC can be performed safely in Afghanistan with comparable outcomes in terms of complications, conversion rates, and ALOS to other countries of the region and the world. Proper case selection and careful preoperative evaluation and management can decrease further conversion, intra- and postoperative complications.

The case is presented of the successful removal of a dead Ascaris lumbricoides from the right hepatic duct of a middle aged woman from a rural province in Afghanistan. The case was started laparoscopically, but converted to an open procedure because of difficulty identifying the anatomic landmarks required to safely perform laparoscopic cholecystectomy. After worm removal, the common bile duct (CBD) was reconstructed with a Roux-en-Y hepaticojejunostomy. The patient was discharged on postoperative day 7 and was doing well when seen in the outpatient clinic 2 weeks later.