Qurat-ul-ain, Rehana Yousaf, Mehrosh Sarfraz, Muneeb Sarfraz
Gallstone disease is a major health problem worldwide particularly in the adult population. Previously complicated gallstone disease was considered to be a contraindication for laparoscopic cholecystectomy. This initial reluctance has slowly evaporated as a result of increasing expertise. Laparoscopic cholecystectomy can be a safe and effective treatment option for complicated gallstone disease. OBJECTIVE: To compare the outcome of laparoscopic and open cholecystectomy in patients with complicated gallstone disease. STUDY DESIGN: Randomized Controlled Trial SETTING: The study was conducted in Allied Hospital, Faisalabad DURATION OF STUDY: Six month from the date of approval of synopsis from board of study April, 2018 to Oct, 2018 METHODLOGY: Total of 372 patients fulfilling the criteria was included for study. A written informed consent was taken from every patient participating in this study. The patient was randomly divided into two equal groups. In group-A laparoscopic cholecystectomy was done. Each patient of both the groups received identical general anesthesia. At introduction, it is 1to 2 ml/kg propofol, 0.05 mg/kg atracurium. During reversal, 2.5-5.0 mg neostigmine and 1.2-2.4 mg atropine was used. In group B open cholecystectomy was done which includes 86 patients. The surgery was performed in North Surgical ward by consultant surgeon. Injection Ceftriaxone 1 gram I.V. was given half hour before surgery and then surgery was performed according to the randomization. The entire patient received injection Ketorolac 30 mg i.v. 8 hourly and postoperative injection Nelbufin 6 mg i.v.12hourly as standard in all patients and Post-operative pain was assessed Visual analog scale after 24 hours. Patients were discharged according to the hospital guidelines for discharge of the patient. All the patients were followed up in OPD on 7th day for post-operative complications observation, monitoring and biopsy report. Data was entered in SPSS-20 version. Quantitative variables like age and hospital stay were presented as mean ± SD. Qualitative variables like gender and postoperative pain was presented as frequency percentage. RESULTS: The mean age of patients in open group was 41.28 ± 13.75 years and in Laparoscopic group was 43.46 ± 13.90 years. In Open group there were 80(43%) male and 106(57%) female cases while in Laparoscopic group there were 65(34.9%) male and 121(65.1%) female cases. The mean hospital stay was statistically shorter in Laparoscopic group (3.80 ± 1.37 days) as compared to Open group (5.12 ± 1.58 days), p-value <0.001. In open group 77(41.4%) cases had post-operative pain and in Laparoscopic group 27(14.5%) cases had post-operative pain. The post-operative pain was statistically higher in open groups, p-value < 0.001. CONCLUSION: Through the findings of this study it is concluded that laproscopic is an ideal treatment option in terms of less pain and shorter duration of hsopital stay as compared to open cholecystectomy for patients with complicated gallstone disease. By opting laparoscopic treatment option, we can decrease the nosocomial infection, work load to the hospital, economic burden and quantity of analgesia needed in post-operative days. KEYWORDS: Laparoscopy, Cholecystectomy, complicated Gallstone, Post-operative pain, infection, hospital stay.