Head of Surgical Hospital General Surgery Resident Outcome of Gallbladder Surgery at Al-Shifa Medical Complex ( One Year Experience) Dr. Marwan Abusada Head of Surgical Hospital ( Al-Shifa M.C) Dr. Mohammed Hararah General Surgery Resident

Retrospective study started on 1. 1. 2016 to 31. 12 Retrospective study started on 1.1.2016 to 31.12.2016 comparing the outcome of gallbladder surgery at al-shifa medical complex with international standards .

Objectives To assess the pattern and the performance of surgical team To determine the rate of complications among operated cases

Methodology Retrospective study About 380 patients file were reviewed by the surgical team at al-shifa hospital Different variables included ,age ,gender,length of stay , admission route , cause of admission ,type of surgery , complications , drain usage.

Inclusion criteria All pateints who underwent surgery for isolated gall bladder disease

Data were analysed by SPSS version 22

About 80 cases admitted to our surgical department due to gallbladder diseases treated conservatively ,but disappeared without follow up later . These cases were excluded from our study .

19 cases were non-operable cases due to advanced stage of tumors as gallbladder tumor or cholangiocarcinoma . The remaining 281 cases were the true cases included in this study .

Age

Mean age of patient was 43.7y

Causes of admission

All patient with obstructive jaundice had ERCP before surgery. One patient had ERCP after surgery due to missed stone in this study .

Type of surgery

Complication rate

complications

Average length of stay

Drain insertion

UpToDate 90 % of cholecystectomies in the United States are performed Laparoscopically Laparoscopic cholecystectomy complications were reported in as many as 5 % of patients.

In a study that combined the data from seven large studies with a total of 8856 laparoscopic cholecystectomies , serious complications occurred in 2.6 percent . A combined review of eight large studies of laparoscopic cholecystectomies reported the following types and frequencies of major complications: bleeding (0.11 to 1.97percent), abscess (0.14 to 0.3 percent), bile leak (0.3 to 0.9 percent), biliary injury (0.26 to 0.6 percent) bowel injury (0.14 to 0.35 percent) The rate of wound infections and surgical site infections is lower with the laparoscopic approach than with the open approach, but there is no advantage in terms of intra-­abdominal abscess formation .

References 1. Strasberg SM. Biliary injury in laparoscopic surgery: part 1. Processes used in determination of standard of care in misidentification injuries. J Am Coll Surg 2005; 201:598. 2. Strasberg SM. Biliary injury in laparoscopic surgery: part 2. Changing the culture of cholecystectomy. J AmColl Surg 2005; 201:604. 3. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:101. 4. Thurley PD, Dhingsa R. Laparoscopic cholecystectomy: postoperative imaging. AJR Am J Roentgenol 2008; 191:794. 5. Biscione FM, Couto RC, Pedrosa TM, Neto MC. Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy. Infect Control Hosp Epidemiol 2007; 28:1103

Conclusion The outcome gallbladder surgery at al- shifa medical complex is congruent with international standards in terms of complication rates . It's recommended to change the policy of drain insertion that cause delay of hospital discharge . Its recommended to shorten the length of stay .

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