Background: Laparoscopic Cholecystectomy (LC) has become the treatment of choice for symptomatic gallstone disease. But it becomes difficult to perform safely and some cases require conversion to Open Cholecystectomy (OC). There is no clear consensus among the laparoscopic surgeons to determine preoperative parameters that can predict difficult laparoscopic cholecystectomy. The aim of this study is to predict the difficult laparoscopic cholecystectomies by correlating with preoperative clinical and radiological findings. Materials and methods: This prospective observational study was performed in the Department of Surgery at Chittagong Medical College Hospital for a period of one year from April 2018 to March 2019. The sample size was 151. Pre-operative clinical and ultrasonographic criterias were correlated with intraoperative difficulties encountered. Peroperative difficulties were considered in terms of pericholecystic adhesion, difficult callots triangle dissection, difficult GB bed dissection and unusual bleeding during surgery. Results: Out of 151 patients underwent LC in this study; 93 (61.6%) cases the procedure was uneventful and the other 58 (38.4%) procedures were difficult. Among those difficult 58 cases, 13 (8.6%) patients required conversion to open cholecystectomy. Difficult LC were found in BMI >30kg/m2, hospitalization for 3 or more times due to acute painful attack and GB wall thickness >3 mm. Conclusion: Pre-operative prediction of difficult LC can be determined by correlating with clinical and radiological findings that help the surgeons to better prepare for intra-operative difficulties and risk of conversion to open cholecystectomy. IAHS Medical Journal Vol 4(2), December 2021; 70-73

Background: The timing of cholecystectomy for acute cholecystitis has been debated with most studies favoring early cholecystectomy. However, most surgeons in Bangladesh prefer to delay surgery in the acute phase. The study aimed to compare between early Laparoscopic Cholecystectomy (LC) with that of delayed laparoscopic cholecystectomy in the management of acute calculus cholecystitis. Materials and methods: This quasi-experimental study included a total of 74 patients with a diagnosis of acute calculous cholecystitis as per Tokyo guideline from the Surgery Department, Chittagong Medical College Hospital, during August 2019 to July 2020. Thirty-seven patients underwent early cholecystectomy (Within 7 days of onset of symptoms) and 37 patients underwent elective or delayed cholecystectomy (After a gap of 6-8 weeks from the acute attack). Peroperative events, postoperative complications, length of hospital stay and days needed to return to full activity were compared between two groups. Results: Both early and delayed groups were similar in-terms of their baseline demographic and clinical characteristics. Significantly higher number of patients in the early group had difficult Callot’s triangle dissection (59.4% vs. 27.1%, p<0.01) and lower number of patients had difficult gallbladder bed dissection (5.4% vs. 37.8%, p<0.001) than the delayed group. The proportion of the patients required conversion to open surgery was 10.8% and 6.1%, respectively in early and delayed group (p=0.691). Total hospital stay was shorter in the early surgery group than the delayed surgery group (6.05±0.52 vs. 12.03±1.46 days, p=0.001). Wound infection, duration of hospital stays following surgery, and days need to return to full activity after surgery was similar between two groups. Conclusion: Early cholecystectomy is feasible and safe for acute cholecystitis and is better method of treatment because of its shorter hospital stay, which is a major economic benefit to both the patient and health care system. IAHS Medical Journal Vol 5(2), Dec 2022; 11-14