Abstract
The pathological changes of acute cholecystitis between early edematous and late chronic fibrotic inflammation beyond 72hours is a well described phenomenon. Early laproscopic cholecystectomy is safe in acute cholecystitis but the effect of time in clinical severity and pathology of acute cholecystitis remains controversial. The aim of this study is to analyse the impact of duration of symptoms on clinical severity, pathology and surgical outcome in patients who underwent laproscopic cholecystectomy in late stages of acute cholecystitis because of late admission, failure of conservative management and recurrence of symptoms during waiting period for delayed laproscopic cholecystectomy. A prospective analysis of 82 patient are done by dividing into two groups early laproscopic cholecystectomy <72h. (ELC) and late laproscopic cholecystectomy 4day to <6 weeks (LLC). Out of 82 PATIENTS 39(47.56%) underwent ELC at <72h. and 42(51.21%) underwent LLC at >72h to <6 weeks. Clinically in the ELC group the majority are mild and In the LLc group majority are moderate and severe in severity grading as per graded as per Tokyo guidelines. Surgical findings andhistopathology show no significant difference in distribution of simple, phlegmonous and gangrenous cholecystitis between both groups and difficult gall bladders with frozen calot, s triangle with complete visual road block were similar in both groups. Majority are completed by a standard four port technique and only 7 patient of both ELC AND LLC are done by" Inner View Assisted Fundus First Retrograde Dissection Technique" to avoid conversion to open cholecystectomy. There is no significance difference between operating time, return to normal activites andhospital stay between both groups. There is no conversion to open cholecystectomy because of use of "Inner view assisted fundus first retrograde dissection technique in laproscopic cholecystectomy, no intra-abdominal collection, no bile duct injury. There are port site wound infections in 3 and 2 in ELC and LLC groups, biliary leak in 2 and 1 in ELC and LLC respectively and no mortality in either groups. Degree of inflammation is not a time dependent phenomenon instead every individual in this universe is uniquehaving different quintescence and inheritance with different response to different stimuli including inflammation. Timing does not influence the convertion rate and LC can be safely performed in late stages of acute cholecystitis provided experienced laproscopic surgeons perform the procedure.