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Muscle splitting open cholecystectomy

Rajbhandari Ashish Prasad

 Laparoscopic cholecystectomy is now regarded as the gold standard treatment for symptomatic cholelithiasis.  Muscle splitting mini cholecystectomy is a good alternate option for those who are not fit for the laparoscopic procedure and in those institutes where the laparoscopic facilities are not available. It is the muscle division which is supposed to be responsible for postoperative pain and the resultant local and systemic effects.

All cases of symptomatic cholelithiasis were advised laparoscopic cholecystectomy and only those cases which opted for open cholecystectomy or were not fit for the laparoscopic procedure were included in the study.25 cases of consecutive open cholecystectomies underwent muscle splitting procedure from June 2016 to May 2018 at Stupa Community Hospital, Jorpathi, Kathmandu, Nepal. 17 were female and age ranged from19 – 82 years.  I case was of morbid obesity with a weight of 99.6 kg and BMI of 44.  2 cases were of preoperative diagnosis of empyema gallbladder and 1 case was of perforated gall bladder. The subcutaneous fat thickness ranged from 1.5 to 4 inches. All cases had a transverse incision in the RUQ around the tip of the 9th coastal cartilage; the length was usually around 5 cm ( mini cholecystectomy)except for the complicated cases which extended to 7 cm. Drain was kept in the 3 complicated cases. The duration of surgery varied from 35- 85 mins.

Post operative pain scale was taken in all cases, on 1st post operative day pain scale ranged from 4-6 and on 2nd post operative day 2-5. 22 cases (except the complicated cases) were discharged on the 2nd post operative day. All cases with drain had an uneventful period with no leakage of bile and were removed on the 3rd post operative day and discharged on the 5th post operative day after completion of a course of antibiotics.

Muscle splitting cholecystectomy is a good alternative to traditional rectus muscle dividing open cholecystectomy and maybe comparable to laparoscopic cholecystectomy as it offers less post operative hospital stay, post operative pain and discomfort with no increased incidence of intra or post operative complications and can be safe and effectively performed  where  and when needed. And for all these regards muscle splitting mini cholecystectomy may be regarded as a

new gold standard for open cholecystectomy