DefinePK

Research Objective

To determine the comparison between the outcomes of early and delayed laparoscopic cholecystectomy among patients presenting with acute cholecystitis.

Methodology

Prospective Randomized Controlled Trial conducted at Dr. Akbar Niazi Teaching Hospital, Islamabad, from September 2022 to February 2023. 108 patients were divided into two groups: Group-A (surgery before 7 days of symptom onset) and Group-B (surgery after 7 days of symptom onset). Outcomes measured included hospital stay and operating time. Data was analyzed using SPSS version 23, with numeric data presented as mean ± standard deviation and categorical variables as frequency and percentage. Chi-square test was used for qualitative data analysis, with a p-value < 0.05 considered significant. Stratification was used to control for age, gender, and hypertension.

Methodology Flowchart

                        graph TD
    A["Patient Recruitment n=108"] --> B["Randomization"];
    B --> C["Group-A: Early Surgery <7 days"];
    B --> D["Group-B: Delayed Surgery >7 days"];
    C --> E["Laparoscopic Cholecystectomy"];
    D --> E;
    E --> F["Data Collection Hospital Stay, Operating Time, Complications"];
    F --> G["Data Analysis SPSS v23, Chi-square test"];
    G --> H["Comparison of Outcomes"];
    H --> I["Conclusion"];                    

Discussion

The study's findings suggest that early laparoscopic cholecystectomy is preferable for acute cholecystitis due to shorter hospital stays and operating times. While complications like surgical site infection, bile duct injury, and conversion rates were comparable between early and delayed surgery, the overall trend favors earlier intervention. The discussion references several other studies that support these findings, though some literature suggests potential differences in bile duct injury rates.

Key Findings

Mean hospital stay was significantly shorter in Group-A (9.26±2.43 days) compared to Group-B (15.41±3.37 days) (p = 0.001). Mean operating time was also significantly less in Group-A (64.93±6.68 min) compared to Group-B (72.78±8.03 min) (p = 0.001). Conversion to open cholecystectomy, bile duct injury, and surgical site infection were comparable in both groups.

Conclusion

Early laparoscopic cholecystectomy is safe and associated with fewer complications and lower conversion rates compared to late cholecystectomy for acute cholecystitis.

Fact Check

1. Sample Size: The study included a total of 108 patients, with 54 patients in each group (Group-A and Group-B).
2. Hospital Stay: The mean hospital stay for early surgery (Group-A) was 9.26±2.43 days, while for delayed surgery (Group-B) it was 15.41±3.37 days.
3. Operating Time: The mean operating time for early surgery (Group-A) was 64.93±6.68 minutes, and for delayed surgery (Group-B) it was 72.78±8.03 minutes.

Mind Map