BACKGROUND AND OBJECTIVE: LAPAROSCOPIC CHOLECYSTECTOMY (LC) is now used in the management of acute cholecystitis. The aim of this study was to evaluate the role of LC for acute cholecystitis (AC) and compare it with acute open CHOLECYSTECTOMY (OC) and elective LAPAROSCOPIC CHOLECYSTECTOMY (ELC) in terms of complications, conversion rate, and hospital stay and operation time.METHODS: This clinical study was carried out 01) 235 patients. Ninety-four patients with AC were admitted to emergency department. They were randomly divided into acute LAPAROSCOPIC CHOLECYSTECTOMY (ALC) (n=46) and OC(n=48). One hundred and forty one patients with symptomatic gallstone underwent ELC.FINDINGS: The median of total stay was 5, 3 and 2 days (mean±SD 5.39±2.9, 3.39±3.14 and 1.99±1.3 days) in OC, ALC and ELC, respectively (p=0.005). The mean duration of operation time was 53.2±3.2, 58.8±29.3 and 39.9±18.8 minutes in OC, ALC and ELC, respectively (p=0.005). Major complications occurred in 5 patients (10.4%) with ac, 2 patients (5.1%) with ALC and 5 patients (3.6%) with ELC. CONCLUSION: The results of this study showed that in patients with ALC in comparison to OC, there are a decrease in total hospital stay, post operative hospital stay and major complications. LC should be considered as a first choice before open surgery.

LAPAROSCOPIC CHOLECYSTECTOMY (LC) in elective surgery has replaced open CHOLECYSTECTOMY (OC) . This study compared the safety and efficacy of these two methods in the treatment of symptomatic gallstones. This experimental parallel outcome study was carried out in Yazd . 140 cases were divided into two groups . 70 cases in LC (M.F=14.54) and 70 in OC (M.F=12.58). Respiratory complications in OC was two fold of LC, biliary injury in both groups were identical (1.4%). The mean hospital stay in OC was 4.08+ 1.9 days and in LC 1.57+0.75 days (P>0.001) . Also , the Mean of NPO time in post operative period in OC was 1.84+0.58 and in LC 1.50 + 0.23. In addition , 2.8% of patients in OC has wound infection and in one patient of LC has subcutaneous hemorrhage . LC provides a safe and effective treatment for most patients with symptomatic gallstones , Laparoscopy

Background: Surgical technique using small-diameter instruments and single-incision laparoscopy are two new options for less invasive LAPAROSCOPIC CHOLECYSTECTOMY (LC). In this study, we have compared mini-LC (MLC) with single-incision LC (SILC). Materials and Methods: This study is a randomized clinical trial conducted on the patients diagnosed with symptomatic cholelithiasis who underwent LC. Forty patients were randomized to two equal groups of MLC and SILC. They were compared in terms of demographic data, operation time, and surgical complications.Results: Baseline characteristics were similar in two groups. Operation time in MLC was significantly shorter than that in SILC (45.1 ± 69 min vs 63.75 ± 7.57 min, P-value<0.001). Also, the total length of the wound in SILC group was shorter than that in MLC group (P-value<0.003). Postoperative pain scores were similar in two groups. Hospital stay was shorter in MLC (1.2 ± 0.6 days vs 1.6 ± 0.8 days, P<0.021). There was no difference in postoperative complications in two groups.Conclusion: MLC because of less operation time is preferred than SILC. Also, by subjective measures, it was a more comfortable method compared to SILC.

Background: A significant proportion of individuals undergoing CHOLECYSTECTOMY for symptomatic cholelithiasis persist with symptoms even after surgery.Objectives: This study was aimed to test our hypothesis that age of presentation and duration of symptoms are the risk factors that predispose to negative symptomatic outcome after CHOLECYSTECTOMY.Patients and Methods: 351 patients with diagnosis of symptomatic gallstones admitted to a tertiary care hospital for elective laproscopic CHOLECYSTECTOMY over a period of three years from 2009. They were provided a standard symptom questionnaire to evaluate the symptomatic outcome and to compare the quality of life at interval of one, three and six months after the procedure regarding the presenting symptoms at the time of admission. Out of 351 patients, 51 patients refused to continue participation in the study and were excluded from the study group. The remaining 300 patients were followed till six months after procedure.Results: 55.66% of patients were highly satisfied after CHOLECYSTECTOMY with regard to alleviation of preoperative symptoms, while 34.33% of patients were satisfied with the treatment. A minority of 8.6% of patients perceived no change with regard to preoperative symptoms, while 1.3% of them had worsening of symptoms.Conclusions: We conclude that management of gall bladder stone disease should be tailored precisely with respect to the quality of life index, with increased emphasis on early detection and treatment as well as increased emphasis on counseling in an elderly cohort after considering the prognosis after CHOLECYSTECTOMY differentially.

Objective: The most common indication for abdominal surgery in elderly (65&01der)is gallstone disease.The elderly are more prone to complication of such surgery due to their other co-morbidity and thus they may benefit mostly from a safer method of surgical procedure. The purpose of this study was to evaluate the safety and outcome of LAPAROSCOPIC CHOLECYSTECTOMY in elderly compare to the conventional method. Methods & Materials: Via prospective study from June 2005 to March 2008 included all patient older than 60 years of age who underwent CHOLECYSTECTOMY by open (Group A) and LAPAROSCOPIC (Group B) method in Milad Hospital. The demographic data (sex.age), American Society of Anesthesiologists’ (ASA) score, postoperative mortality morbidity, length of stay and operative time were recorded for each patient and were compared between two methods. Data of patient’s analysis by SPSS with chi-square and t test. Results: The study included 311 elderly (34% men and 66% women) .Hundred fifty-seven patients underwent open CHOLECYSTECTOMY, 154 patient underwent LAPAROSCOPIC CHOLECYSTECTOMY. The mean age was 7141 years. The outcome in group B (LAPAROSCOPIC)included: morality %0, morbidity 2%, postoperative hospital stay l1/days ,mean operation time was 40 minutes. In group A(open): mortality and morbidityrate were 21%1and 12% respectively with postoperative hospital stay331days and similar operation time as group A. Conclusion: LAPAROSCOPIC CHOLECYSTECTOMY is the gold standard treatment and safe procedure in elderly patient and aging is not considered to be a contraindication LAPAROSCOPIC surgery in such patients.

Background: The incidence of complications of LAPAROSCOPIC CHOLECYSTECTOMY has increased dramatically since the introduction and widespread use of LAPAROSCOPIC CHOLECYSTECTOMY in 1990. Bile duct injuries are among the most important complications of this approach.Methods: From January 1998 to January 2002, a total of 155 LAPAROSCOPIC CHOLECYSTECTOMY were performed at the Loghman Medical Center. A retrospective analysis of bile duct-related complications was carried out.Results: There were 6(4.4%) major complications including major bile duct injury, cystic duct leak, bile duct strictures, and hemorrhage that required laparotomy at later stage,Conclusion: Results revealed that LAPAROSCOPIC CHOLECYSTECTOMY is an operation associated with low morbidity and mortality rate, but bile duct injury is still a major concern. We believe that clear demonstration of anatomy is the cornerstone of safe, successfulLAPAROSCOPIC CHOLECYSTECTOMY.