LAPAROSCOPIC CHOLECYSTECTOMY FOR EMPYEMA GALL BLADDER

Empyema Gall Bladder

Abstract

Objective: To describe the experience of treating empyema gall bladder with laparoscopic cholecystectomy.
Study Design: Descriptive observational study.
Place and Duration of Study: The study was carried out at Combined Military Hospital (CMH) Peshawar, from Feb 2012 till May 2014 for a period of twenty eight months.
Material and Methods: Twenty eight patients were enrolled in the study who fulfilled the criteria for empyema and were willing for laparoscopic cholecystectomy, chances of conversion to open cholecystectomy and risk of complications involved. We defined the operative difficulty levels according to the intra-operative findings. Level 1-adherent omentum, level 2–oedematous gall bladder wall, level 3–necrotic gall bladder wall, level 4–adherent gut and level 5 – adherent Hartmann’s pouch and oedematous Calot’s triangle having no defined planes. The results were noted in terms of time taken for the operation and complications of the operative procedure.
Results: Twenty eight patients of empyema gall bladder underwent laparoscopic cholecystectomy. Mean age was 46.2 ± 7.1 years. Average duration of symptoms was 4.1 ± 2.3 days. Two patients had level-I operative difficulty, 6 patients had level-II difficulty, 9 patients had level-3 difficulty, 2 patients had level-IV difficulty and 9 patients had level-V difficulty. In 21(75%) patients total cholecystectomy was performed, anterior partial cholecystectomy was done in 2 patients (7.1%) and 5 patients (17.9%) were converted to open cholecystectomy. One patient (3.5%) had Stresburgh Bismuth type D injury and was managed by open exploration and T-tube placement. No mortality was encountered in the study group.
Conclusion: The technique of laparoscopic cholecystectomy can be used effectively for treating empyema gall bladder specifically in American Society of Anaesthesiologists (ASA) I & II patients. Further randomized
controlled trials can elaborate its efficacy. This will not only prove to be cost effective but it will also add to the comfort of the patient.