Early post-operative course and complications in laparoscopic versus open cholecystectomy
Background: Laparoscopic Cholecystectomy (L.C) is now considered the gold standard in gallbladder surgery. However, Open Cholecystectomy (O.C) is still being performed widely in Iraq. Both types of surgeries have unique problems in the early post-operative period which need to be recognized and dealt with properly. Even with better experience in laparoscopic surgery, complications in the early post-operative period should be expected and addressed promptly and efficiently. Aims: To observe and compare the clinical events in the early post-operative period (the first 48 hours) following L.C and O.C, and to recognize the special problems arising during this period. Also, to document and compare the early post-operative complications in both types of surgeries and the methods applied to deal with these complications.
Patients and Methods: All patients admitted for cholecystectomy (open and laparoscopic) to the 2nd surgical team at Al-Yarmouk Teaching Hospital for one year were included in the study. They were evaluated pre-operatively and followed post-operatively with full documentation of the surgical procedures, findings and intra-operative complications. Early post-operative course starting from anesthetic recovery till discharge from hospital was followed very closely and documented. General and specific complications in the early post-operative period were studied and their management observed in details.
Results: The number of patients operated upon was 110, 58 laparoscopicaly and 52 by open surgery. In the L.C group , the average pain score in the first 24 hours was 1 compared to 3 in the O.C group patients with L.C were given analgesia on day zero only, while 25% of patients with O.C received analgesia on day one also. Early nausea was present in 90% of patients in L.C group VS. 90% in O.C group, the L.C group 10.4 % had respiratory symptoms vs. 23.1% with O.C patients with L.C had earlier return of bowel function. In the LC group, there were 17 episodes of bleeding vs 4 episodes in the O.C group. In the L.C group 2.8% had common bile duct injury vs 4.6% in O.C group. Post-operative bile leak was 2.8% in L.C vs 1.9% in O.C, while spillage of gallstones was higher in L.C(65.6% vs. 9.7%). Conclusions: The early post-operative course is smoother in the L.C group although with better anesthetic techniques and good post-operative care, the course following O.C is improving. Vascular complications related to trocar site, blood vessels and solid organs mainly liver were more in the L.C group. Bile leakage and gallstone spillage were more with L.C but bile duct injuries more with O.C. Better training of surgeons is needed to improve the learning curve and decrease the incidence of complications.