No abstract

Calculous cholecystitis is a major and common health problem, and nowadays laparoscopic cholecystectomy is the preferred approach for its surgical management but timing of surgery is a matter of debate especially in presence of acute inflammation of the gall bladder. The aim of this study is to compare the outcome of early and delayed laparoscopic cholecystectomy for acute cholecystitis. This retrospective comparative study was done in two tertiary hospitals in Basrah from July 2010 to July 2017. It involved 122 cases (98 females 80.3% and 24 males 19.7 %). Forty two (34.5%) underwent early laparoscopic cholecystectomy within 4 days of symptoms and 80 patients (65.5%) underwent delayed operation within 6-12 weeks of first presentation. The two groups were comparable in regard to demographic and clinical points of view. The age of studied patients lies between 20-65 years. The operative time was not identical for the two groups (P=0.004), early treated cases tended to take longer operative time. Hospital stay was significantly longer in early cases as compared to delayed cases (p=0.000). Bile leak happened in only one case (2.4%) of the early group and was managed successfully and discharged well. Bleeding and respiratory infection were extremely rare in both groups. Conversion rate was 4.8% and 5% for the early and delayed group respectively and the difference was statistically not significant (p value 0.661). In conclusion, early laparoscopic cholecystectomy in acute cholecystitis is safe and feasible in selected patients with no difference in morbidity and mortality if it done during the 1 st four days of beginning of symptoms, but the operative time is longer than delayed operation.

No abstract

Background: Hemoglobinopathies are common genetic disorders affecting the synthesis of one of the globin chains of hemoglobin molecule. Laparoscopic cholecystectomy is the standard procedure for treatment of patients with normal hemoglobin and symptomatic gall stones, but doubt is still to date regarding safety of this procedure in patients with hemoglobinopathy. Aims: 1. To assess the safety of laparoscopic cholecystectomy for hemoglobinopathic patients, 2. To describe the perioperative events that might happen before, during or after this procedure. Patients and Methods: This is a record-based comparative study conducted over a period of seven years, involved 62 hemoglobinopathic patients and 148 patients with normal hemoglobin variant. All underwent laparoscopic cholecystectomy and comparison done regarding perioperative events. Results: The overall complication rate was 56.5% in hemoglobinopathic patients and 21.6% in the other group and the difference was statistically significant (P-value ˂0.001). Vaso-occlusive crisis occurred in 9 patients (14.5%), respiratory complications (atelectasis and bronchitis) in (9.7%), acute chest syndrome in (4.8%) and hemolysis in (4.8%). Conclusions: 1. Laparoscopic cholecystectomy is safe in well prepared hemoglobinopathic patients but it is associated with significantly higher rate of disease related complications, namely acute chest syndrome, hemolysis and vaso-occlusive crises.2-Hemoglobinopathic patients require special pre, intra and post-operative care which should be offered by the surgeon, the physician and the anesthetist

No abstract