Abstract:
Objective: To study the feasibility ,advantages and disadvantages of combined cholecystectomy at the time of cesarean section, and to compare laparoscopic versus mini-laparotomy approache.
Material and methods: This study comprises of 36 patients scheduled to have combined cholecystectomy at the time of cesarean section After obtaining informed surgical consent , all patients have been subjected to combined L.S.C.S. and cholecystectomy at the same time. The patients have been divided into two groups, group A (18 cases) subjected to laparoscopic cholecystectomy. Group B (18 cases) subjected to cholecystectomy using minilaparotomy approach after assessing the anatomy via cesarean section wound.
Results:. The mean operative time in group A was 65 minutes versus 85 minutes in group B. No conversion from laparoscopic to open cholecystectomy was needed especially in those with potential technical difficulties, the procedure has been accomplished successfully by laparoscopy. Three cases of group B needed wound extension to facilitate cholecystectomy. Only one case in group B developed wound infection in the subcostal wound incision. The average hospital stay was 2 days and 4 days for group A and group B respectively.
Conclusion: Combined cesarean section and cholecystectomy is feasible and has many advantages like single anaesthesia, single hospitalization, low cost, less drug therapy and safe to the mother and fetus.
Laparoscopic cholecystectomy is better than minilaparotomy cholecystectomy in operative and post-operative periods.
Silent gall stones patients undergoing cesarean section under general anaesthesia are best treated by cholecystectomy at the same time to avoid the complications of gall stones in young patients.
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