1SAIF AHMAD, 2HUMAID AHMAD, 3AREEBA SAIF, 4RIAZUL HASSAN, 5UMER FATEH

ABSTRACT

Introduction: Laparoscopic Cholecystectomy (LC) is yet to be fully established in developing countries due to lack of economic resources and training facilities. These limitations dictate that an approach be used whereby laparoscopic technique can be established without the need of attending costly training sessions. This study was aimed to describe the strategy that we used to introduce LC in our hospital and to present the outcome of the initial 250 cases. Design: Prospective Study,
Place and Duration of Study: Sindh Government Qatar Hospital (SGQH), Karachi, Pakistan from January 2009 to July 2011.
Patients and Methods: The strategy used involved initial detailed literature review regarding LC, practice with instruments using a costless endotrainer, initial careful case selection and hands-on supervision of the first 25 cases by an experienced laparoscopic surgeon. Initially selected patients included those with duration of symptoms less than 6 months, thin patients and patients with gallbladder wall thickness of up to 4 cm on ultrasound. Outcome in terms of conversion rate, postoperative recovery, complications including CBD injury and mortality is described.
Results: The mean operative time for the first 25 cases was 89 minutes and overall was 46 minutes. Four (1.6%) patients were converted to open procedure. 153 (61.2%) were discharged by the 3rd postoperative day. 35 postoperative complications were detected in 22 (8.8%) patients with rate of CBD injury being 1.2%. Major complications occurred in 8 (3.2%) patients. The mortality rate was 1.2%.
Conclusion: Our results indicate that the strategy we used to introduce LC in our setup was successful in establishing the procedure with an initial slightly higher but comparable complication rate.
Key words: Laparoscopic cholecystectomy, initial experience, common bile duct injury, gallbladder disease, complications, Karachi, Pakistan

For Full text contact to:
Prof. Dr. Farah Mansuri
editor@annals-ashkmdc.org

1,2,4,5 Department of Surgery, Sindh Government Qatar Hospital, Karachi.
3 Medical Student, Dow Medical College,Dow University of Health Sciences, Karachi