Outcome of patients undergoing laparoscopic cholecystectomy with previous upper and lower abdominal surgeries

Background: laparoscopic cholecystectomy (lc),after its advent in 1987,rapidly established itself as the gold standard treatment of gallstones. the operation is not completely risk free,some incidents and complications being more frequent than with open cholecystectomy. however,there are still a substantial proportion of patients in whom lc cannot be successfully performed and conversion to open surgery is required. aim: to determine the outcome of patients undergoing laparoscopic cholecystectomy with previous upper and lower abdominal surgeries. methods: this descriptive case series study of 500 patients of both gender aged between 35-45 years was conducted in surgical units of mayo hospital,lahore in one year duration from 01-01-2014 to 31-12-2014. the non-probability purposive sampling technique was used in this study. written consent was obtained from the patients. only the most senior consultants skilled in laparoscopic surgery were the part of team. demographic profile was recorded including age,gender and address. previous history of abdominal surgeries (type,duration and complication if any),operative time of lc,adhesions per operatively and hospital stay was recorded. wound infection was assessed clinically by purulent discharge within 10 days post-operatively. statistical analysis of data was done using spss v.17.0 for windows. quantitative variables were presented in the form of mean±sd and qualitative variables and type of previous abdominal surgeries was presented in the form of frequency and percentages. results: among 500 patients,255(51%) were male and 245(49%) female. the mean age of the patient was 39.78±2.95 years,mean operative time 54.05±8.75 minutes and mean hospital stay 3.42±1.06 days. there were 275(55%) patients with previous lower abdominal surgery and 225(45%) with previous upper abdominal surgery. adhesions was found in 325(65%) patients per operatively and 14(2.8%) had wound infection post operatively. by using t-test,there was significant difference between type of previous abdominal surgery and operative time (p-value=0.023) but insignificant difference between type of previous abdominal surgery and hospital stay (p-value=0.374). we also used chi-square test to check the association,there was no significant association between type of previous abdominal surgery and wound infection (p-value =0.479).also no significant association between type of previous abdominal surgery and adhesions (p-value =0.48). conclusion: in-spite of more adhesions and more operative time,it was found that wound infection and hospital stay was less in patient undergoing lc with previous abdominal surgeries. hence lc is still the good choice in these patients.