Mini-Cholecystectomy under Local Anesthesia for Symptomatic Gallstone Patients Unfit for General Anesthesia

Abstract

Background:: Reports of open-Cholecystectomy (OC) or laparoscopic Cholecystectomy (LC) under general anesthesia (GA) in the surgical treatment of gallbladder disease are common, but those performed under local anesthesia (LA) are much more limited, especially for old aged patients unfit for GA.

Objectives: This study try to show that Mini-Cholecystectomy (MC) under LA for symptomatic gallstone disease is safe and effective in old aged patients, unfit for GA. This study tried to determine the safety and success of Mini-Cholecystectomy under local anesthesia for symptomatic gallstone disease in old aged patients unfit for GA.

Methodology: ninety patients with gallstone disease scheduled for Mini-Cholecystectomy under local anesthesia were included in this prospective study in Erbil teaching hospital and sardam private hospital. Seventy-three patients were female, with a median age of 70 years (range, 50-90). All of the patients had evidence of acute cholecystitis. Mini-Cholecystectomy MC was performed by a standardized technique and under the combination of local anesthesia (1% zylocain without adrenaline) and intravenous administrations of fentanyl (0.001-0.002 mg/kg) and midazolam (0.05-0.1 mg/kg). Statistical analyses were performed using Microsoft Word Excel 2007.

Results: The median operative time was 45 minutes (range, 35-70). Local anesthesia was converted to general anaesthesia in seven patients owing to the severe discomfort caused by lysis of dense adhesions around the gallbladder, giving a success rate of 95.5%. Cholecystectomy was done successfully in 65(72.22%) patients, while cholecystostomy was performed in the remaining 25 (27.77%) patients because of the severe adhesions that rendered Cholecystectomy very difficult. The median hospital stay was 2.6 days (range, 2-7).

Conclusions: Mini-Cholecystectomy (MC) under Local anesthesia (LA) is an effective surgical procedure for old aged patients with acute calculus cholecystitis who are unfit for GA.

Recommendation: It is recommended to study a larger sample for long period to evaluate the late complications of the operation.