Download - Acute Chole Waynad Final With Stats
-
8/13/2019 Acute Chole Waynad Final With Stats
1/19
Does the timing of surgical intervention in
case of Acute cholecystitis alter the
Patient outcome ?
Dr. Aniz Ratani,
DNB Trainee Dept. Of General Surgery.
Dr. Sajeesh Sahadevan, Dr. Rajesh Nambiar,
Dr. Rohit Ravindran .
Department of Gastro Intestinal Surgery
Dr. Rojan Kuruvilla , Dr. Sajan P , Dr. Subhash VC .
Dept Of General Surgery.
Malabar Institute Of Medical Sciences,Kozhikode
-
8/13/2019 Acute Chole Waynad Final With Stats
2/19
Introduction
Laparoscopic cholecystectomy (LC) is the gold standardtreatment
Optimal surgical timing is of major importance and still adebatable issue.
Delayed presentation frequently encountered in a largeurban hospital has therefore resulted in many surgeries
performed within the period of subacute inflammation.
Studies showed readmission of patients before intervalcholecystectomy either due to recurrent biliary colics orunderlying sepsis.
-
8/13/2019 Acute Chole Waynad Final With Stats
3/19
Aims and Objectives
The objective of the study is to see whether the
timing of surgery in acute cholecystitis influencespatient outcomes in terms of morbidity, mortality
and duration of stay in the hospital.
-
8/13/2019 Acute Chole Waynad Final With Stats
4/19
Sample Size and Population
The study was carried out in Malabar Institute of
Medical Sciences from the period of July 2012 to
December 2012, obtaining a sample size of 100.
The patients diagnosed to have Acute
Cholecystitis were divided into 3 groups.
Grp AOperated upon within 7 days of onset of
symptoms.
Grp BOperated between 8thday till 6 weeks.
Grp COperated after 6 weeks of duration.
-
8/13/2019 Acute Chole Waynad Final With Stats
5/19
Material and Methods
Diagnosis.
Grouping.
Surgery performed with standard 4 ports.
Interim-Analysis
-
8/13/2019 Acute Chole Waynad Final With Stats
6/19
Analysis and Results
-
8/13/2019 Acute Chole Waynad Final With Stats
7/19
Population
< 7 days( A ), 50
8 to 6 weeks( B ) ,
39
> 6 weeks(C) ,
11
< 7 days( A )
8 to 6 weeks( B )
> 6 weeks(C)
-
8/13/2019 Acute Chole Waynad Final With Stats
8/19
Mean Age Distribution
44.7 48.23
57.85
0
10
20
30
40
50
60
70
80
A B C
Age (in yrs )
-
8/13/2019 Acute Chole Waynad Final With Stats
9/19
Males Vs Females
37
28
7
13
11
4
0
10
20
30
40
50
60
A B C
Females
Males
-
8/13/2019 Acute Chole Waynad Final With Stats
10/19
Operative Period Time
0
50
100
150
AB
C
93.85
131.72
114.33
Time in minutes
-
8/13/2019 Acute Chole Waynad Final With Stats
11/19
Significance
Group Mean Surgery time Range
A 93.85 35 - 165
B 131.72 75- 224
C 114.33 58 - 181
There is a significant difference in the surgery time
between groups. P value = 0.04 which is < 0.05.
So average surgery time is high in Group B than in
group A
-
8/13/2019 Acute Chole Waynad Final With Stats
12/19
Adhesions
Fibrinous
Dense0
5
10
15
20
AB
C
9
17
0
0
86 Fibrinous
Dense
-
8/13/2019 Acute Chole Waynad Final With Stats
13/19
Demographic and perioperative
Characteristics.Characteristic Group A Group B Group C
Male / Female 37 / 13 28 / 11 7 / 4
Age ( Median ) 44.70 48.23 57.85
Complicated
Cholecystitis
12 21 0
Spillage 3 9 0
Drain use 5 24 0
Operative time * 93.85 131.72 114.33
* p value < 0.05 , significant difference noted
-
8/13/2019 Acute Chole Waynad Final With Stats
14/19
Conversion Rates and CBD injury
0
0.2
0.4
0.6
0.8
1
A B C
Conversion Rates
CBD injury
No significant difference was found between the three
groups in the parameters of conversion rates and CBD
injury.
-
8/13/2019 Acute Chole Waynad Final With Stats
15/19
Complications
Complications Group A Group B Group C Total
Reoperation 0 0 0 0
Sepsis 0 3 0 3
Bile Leak 0 0 0 0
CBD injury 0 0 0 0
Wound infection 3 5 0 8
Paralytic Ileus 2 4 0 6
Others 1 1 0 2
Readmission * 0 0 0 0
Total 19
* till Jan 2013
-
8/13/2019 Acute Chole Waynad Final With Stats
16/19
Average Length of Stay ( days )
0
1
2
3
4
5
6
7
A B C
4.57
6.17
5.19
Days
Days
-
8/13/2019 Acute Chole Waynad Final With Stats
17/19
Significance
Group Mean length of stay ( in days ) Standard Deviation
A 4.57 1.66
B 6.17 3.28
C 5.19 1.83
There was a significant difference in the length of
stay between groups. P value = 0.008 < 0.05.
The average length of stay was found to be lower in
the Group A ( acute group )
-
8/13/2019 Acute Chole Waynad Final With Stats
18/19
Conclusion
The best timing for a cholecystectomy inAcute cholecystitis was within 7 days after theinitial symptoms.
Safe cholecystectomy was possible even after7 days though the operating time and the
hospital stay was slightly more.
Timing of intervention did not increase themorbidity or the mortality.
-
8/13/2019 Acute Chole Waynad Final With Stats
19/19
Thank You