Laparoscopic Cholecystectomy: Review of 1430 Cases in Cure International Hospital, Kabul, Afghanistan

Abstract

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.

Targeted Perioperative Nursing Combined with Propofol and Fentanyl for Gynecological Laparoscopic Surgery

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MRCP and microincision of the cystic duct can prevent residual gallstones: A single-center experience

“…The exclusion criteria were as follows: (1) the presence of common bile duct stones or intrahepatic bile duct stones found by outpatient abdominal ultrasound before admission; (2) gallstones combined with jaundice; (3) alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels greater than 3 times the normal value; (4) creatinine or urea nitrogen levels greater than 1.5 times the normal value; (5) gallstones combined with pancreatitis; (6) severe cardiopulmonary disease or inability to tolerate surgery; or (7) pregnancy.…”

“…However, LC is an indirect operation and lacks the direct touch of the surgeon's hand, compared with traditional open surgery, some serious complications, such as residual gallstones, bile duct damage and biliary leakage are more likely to occur [6]. This is especially problematic for common bile duct stones that do not cause clinical symptoms [7].…”

Serum liver enzyme alterations after laparoscopic cholecystectomy – a study.

“…Laparoscopic approach is the gold standard for cholecystectomy in present era and open approach is adopted only for those specific indications when laparoscopic approach may not be feasible 1 .…”