THE ROLE OF LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS
Keywords:
Acute cholecystitis, Laparoscopic cholecystectomy, early cholecytectomy
Abstract
https://doi.org/10.31386/dmj.2017.11.8
Background: Laparoscopic cholecystectomy has become the treatment of choice for symptomatic gallstone diseases; many surgeons still prefer interval laparoscopic cholecystectomy over early laparoscopic cholecystectomy in acute cholecystitis. The aim of this study is to evaluate the safety of laparoscopy in acute cholecystitis and to determine the best time for early cholecystectomy in acute cholecystitis.
Subject and Methods: A prospective study done at Azadi teaching hospital –department of surgery from June 2013 to December 2014, include 60 cases of acute cholecystitis which had been diagnosed by clinical, laboratory and imaging examinations and underwent early laparoscopic cholecystectomy.
Results: There were 60 patients of acute cholecystitis underwent early laparoscopic cholecystectomy , they were 37 females and 23 males and the median age was 46 years (range 22-80 years), the median operative time was 60 min. , the conversion rate was (6.7%) and postoperative complications rate was (5%).
Conclusions: Laparoscopic cholecystectomy for acute cholecystitis is safe procedure with low morbidity, mortality and conversion rate, and the best time may be within 72 hours of beginning signs and symptoms of acute cholecystitis.
Downloads
Download data is not yet available.
References
1. Lubasch A, Lode H: Antibiotic therapy in cholecystitis, cholangitis and pancreatitis. Internist. 2000, 41:168-174.
2. Tokunaga Y, Nakayama N, Ishikawa Y, Nishitai R, Irie A, Kaganoi J, Ohsumi K : Surgical risks of acute cholecystitis in elderly. Hepatogastroenterology. 1997; 44:671-676.
3. Ziessman HA: Acute cholecystitis, biliary obstruction, and biliary leakage. Semin Nucl Med. 2003; 33:279-296.
4. Browning JD, Horton JD: Gallstone disease and its complications. Semin Gastrointest Dis. 2003; 14:165-177.
5. Schirmer BD, Winters KL: Cholelithiasis and cholecystitis. J Long Term Eff Med Implants. 2005;15:329-338.
6. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002;325:639–643.
7. Elizabeth F, Valerie H , Robb R.
BMJ Clin Evid. 2008; 0411. Published online 2008 December 4. PMCID: PMC2907986
8. Lou MA, Mandal AK, Alexander JL, Bacteriology of the human biliary tract and the duodenum. Arch Surg. 1997;965:112 116.
9. Hoem D, Viste A, Horn A, Gislason H, Sondenaa K: Cholecystectomy improves long-term success after endoscopic treatment of CBD stones. Hepatogastroenterology. 2006; 53:655-659.
10. Strasberg SM, Clavien PA: Overview of therapeutic modalities for the treatment of gallstone diseases. Am J Surg. 1993, 165:420-426.
11. Strasberg SM, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am. Coll. Surg. 1995;180:101–125
12. Serralta A, Bueno J, Planells M, Rodero D. Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. 2003;13:71–5.
13. Jenkins PJ, Paterson HM, Parks RW, Garden OJ. Open cholecystectomy in the laparoscopic era. Br J Surg. 2007; 94 1382–1385.
14. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004; 188: 205–211.
15. Nair RG, Dunn DC, Fowler S, McCloy RF. Progress with cholecystectomy: improving results in England and Wales. Br J Surg. 1997; 84: 1396–1398.
16. David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP. Management of acute gallbladder disease in England. Br J Surg. 2008; 95: 472–476.
17. Papi C, Catarci M, Ambrosio D, Gili L, Koch M, Grassi GB et al. Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol. 2004; 99: 147–155.
18. Lawrentschuk N, Hewitt PM, Pritchard MG. Elective laparoscopic cholecystectomy: implications of prolonged waiting times for surgery. ANZ J Surg. 2003; 73: 890–893.
19. Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G et al. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991; 161: 385–387.
20. Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg. 1996; 20: 43–48.
21. Wilson P, Leese T, MorganWP, Kelly JF, Brigg JK. Elective laparoscopic cholecystectomy for ‘all-comers’. Lancet. 1991; 338: 795–797.
22. Cheema S, Brannigan AE, Johnson S, Delaney PV, Grace PA. Timing of laparoscopic cholecystectomy in acute cholecystitis. Ir J Med Sci. 2003; 172: 128–131.
23. Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S. Role of laparoscopic cholecystectomy in the early management of gallbladder disease. Br J Surg. 2005; 92: 586–591.
24. Nabeel S , Obirize A , Daniel D , metanalysis of early laparoscopic cholecystectomy. JAMA Surg. 2015; 150 (2) :129-136.
25. Senapati P, Bhattarcharya D, Harinath G, Ammori B. A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann. R. Coll. Surg. Engl. 2003; 85: 306–12.
26. Davila D, Mazanares C, Picho ML, Albors P, Cardenas F, Fuster E et al, Experience in the treatment (early vs delayed) of acute cholecystitis via laparoscopy. Cir Esp. 1999; 66:233
27. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L, Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003; 7(5):642–645
28. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004; 18(9):1323–1327
29. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998; 85(6):764–767
30. Lo CM, Liu CL, Fan ST, Lai EC, Wong J , Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998; 227(4):461–467
31. Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M et al , Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14(1):114–121
32. Schwesinger WH, Sirinek KR, Strodel WE , Laparoscopic cholecystectomy for biliary tract emergencies: state of the art. World J Surg. 1999; 23(4):334–342
33. Wiebke EA, Pruitt AL, Howard TJ, Jacobson LE, Broadie TA, Conversion of laparoscopic to open cholecystectomy.An analysis of risk factors". 1996;10(7):742-5
34. Abdulmohsen A. Al-Mulhim, early laparoscopic cholecystectomy, Inc. JSLS. 2008;12:282–287.
35. Muhmad Abdulla, department of surgery, al kadumia teaching hospital in Baghdad, early laparoscopic cholecystectomy versus delay laparoscopic cholecystectomy in acute cholecystitis, thesis of Iraqi board (2012).
36. Stavros G, Nikitas D, Stylianos G , Laparoscopic Cholecystectomy: a Safe Approach for Management of Acute Cholecystitis . JSLS. 2007;11:219–224
37. Reddick EJ, Olsen D, Spaw A, Safe performance of difficult laparoscopic cholecystectomies. Am J Surg. 1991; 161(3):377–381.
38. Dubois F, Levard H, Berthelot G, Mouro J, Karayel M. Complications of celioscopic cholecystectomy in 2006 patients. Ann Chir. 1994; 48(10):899 –904.
39. Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991; 213(6):665– 677.
40. Lujan JA, Parrilla P, Robles R, Martin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs. open cholecystectomy in the treatment of acute cholecystitis: Arch Surg. 1998; 133(2):173–175.
41. Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: World J Surg. 1997; 21(5):540 –545.
42. Zucker KA, Flowers JL, Bailey RW, Graham SM, Buell J, Imbembo AL. Laparoscopic management of acute cholecystitis. Am J Surg. 1993; 165(4):508 –514.
43. Rattner DW, Ferguson C, Warshaw AL. Factors associated with laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993; 217(3):233–236.
44. Chi-Leung Liu, Chung-Mau Lo, Edward C. S. Lai, Early Versus Delayed Laparoscopic Cholecystectomy for Treatment of Acute Cholecystitis. ANN SURG. 1996; 223(1):37-42
45. Bhattacharya D, Senapati PSP, Hurle R, Ammori BJ. Urgent versus interval laparoscopic cholecystectomy for acute cholecystitis: J Hepatobiliary Pancreat Surg. 2002; 9:538 –542.
46. Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed interval laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 2006; 20:82– 87.
47. Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP. Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc. 2000;14:358 –361.
48. Muhammad Najm Khan, Urgent cholecystectomy for acute cholecystitis, Ann R Coll Surg Engl 2009; 91: 30–34.
49. Peters JH, Krailadsiri W, Incarbone R, Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg. 1994; 168(6):555–559.
50. Lujan JA, Parrilla P, Robles R, Laparoscopic cholecystectomy the treatment of acute cholecystitis. J Am Coll Surg. 1995; 181(1):75- 77.
51. Bickel A, Rappaport A, Kanievski V, Laparoscopic surgery of acute cholecystitis. Prognostic factors for success. Surg Endosc. 1996; 10(11):1045–1049.
52. Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis.What is the optimal timing for operation? Arch Surg. 1996;
53. Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998;351:321–325.
54. Mercer SJ, Knight JS, Toh SKC, Walters AM, Sadek SA, Somers SS. Implementation of a specialist-led service for the management of acute gallstone disease. Br J Surg. 2004;91:504 –508.
55. Prakash K, Jacob G, Lekha V, Venugopal A, Venugopal B, Ramesh H. Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc. 2002;16:180 –183.
56. Nanez B, Mutter D, Russier Y. Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg. 2001;25:1352–1356.
57. Adamson S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg. 1997; 184: 571–8.
58. Cox M, Wilson T, Luck A, Jeans P, Padbury R, Toouli J. Laparoscopic cholecystectomy for the acute inflammation of the gall bladder. Ann Surg. 1993; 218: 630–4.
59. Madan AK, Aliabadi-Wahle S, Tesi D, Flint LM, Steinberg SM. How early is early laparoscopic treatment of acute cholecystitis? Am J Surg. 2002;183:232–236.
60. Garber SM, Korman J, Cosgrove JM, Cohen JR. Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 1997;11:347–350.
61. Wael N, Mikael P, Indu S, Yanling Ma, Parakrama C, Rodney J, Prediction of Patients with Acute Cholecystitis Requiring Emergent Cholecystectomy: Hindawi Publishing Corporation Gastroenterology :10.1155/2010/901739
2. Tokunaga Y, Nakayama N, Ishikawa Y, Nishitai R, Irie A, Kaganoi J, Ohsumi K : Surgical risks of acute cholecystitis in elderly. Hepatogastroenterology. 1997; 44:671-676.
3. Ziessman HA: Acute cholecystitis, biliary obstruction, and biliary leakage. Semin Nucl Med. 2003; 33:279-296.
4. Browning JD, Horton JD: Gallstone disease and its complications. Semin Gastrointest Dis. 2003; 14:165-177.
5. Schirmer BD, Winters KL: Cholelithiasis and cholecystitis. J Long Term Eff Med Implants. 2005;15:329-338.
6. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002;325:639–643.
7. Elizabeth F, Valerie H , Robb R.
BMJ Clin Evid. 2008; 0411. Published online 2008 December 4. PMCID: PMC2907986
8. Lou MA, Mandal AK, Alexander JL, Bacteriology of the human biliary tract and the duodenum. Arch Surg. 1997;965:112 116.
9. Hoem D, Viste A, Horn A, Gislason H, Sondenaa K: Cholecystectomy improves long-term success after endoscopic treatment of CBD stones. Hepatogastroenterology. 2006; 53:655-659.
10. Strasberg SM, Clavien PA: Overview of therapeutic modalities for the treatment of gallstone diseases. Am J Surg. 1993, 165:420-426.
11. Strasberg SM, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am. Coll. Surg. 1995;180:101–125
12. Serralta A, Bueno J, Planells M, Rodero D. Prospective evaluation of emergency versus delayed laparoscopic cholecystectomy for early cholecystitis. 2003;13:71–5.
13. Jenkins PJ, Paterson HM, Parks RW, Garden OJ. Open cholecystectomy in the laparoscopic era. Br J Surg. 2007; 94 1382–1385.
14. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004; 188: 205–211.
15. Nair RG, Dunn DC, Fowler S, McCloy RF. Progress with cholecystectomy: improving results in England and Wales. Br J Surg. 1997; 84: 1396–1398.
16. David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP. Management of acute gallbladder disease in England. Br J Surg. 2008; 95: 472–476.
17. Papi C, Catarci M, Ambrosio D, Gili L, Koch M, Grassi GB et al. Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol. 2004; 99: 147–155.
18. Lawrentschuk N, Hewitt PM, Pritchard MG. Elective laparoscopic cholecystectomy: implications of prolonged waiting times for surgery. ANZ J Surg. 2003; 73: 890–893.
19. Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G et al. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991; 161: 385–387.
20. Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg. 1996; 20: 43–48.
21. Wilson P, Leese T, MorganWP, Kelly JF, Brigg JK. Elective laparoscopic cholecystectomy for ‘all-comers’. Lancet. 1991; 338: 795–797.
22. Cheema S, Brannigan AE, Johnson S, Delaney PV, Grace PA. Timing of laparoscopic cholecystectomy in acute cholecystitis. Ir J Med Sci. 2003; 172: 128–131.
23. Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S. Role of laparoscopic cholecystectomy in the early management of gallbladder disease. Br J Surg. 2005; 92: 586–591.
24. Nabeel S , Obirize A , Daniel D , metanalysis of early laparoscopic cholecystectomy. JAMA Surg. 2015; 150 (2) :129-136.
25. Senapati P, Bhattarcharya D, Harinath G, Ammori B. A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann. R. Coll. Surg. Engl. 2003; 85: 306–12.
26. Davila D, Mazanares C, Picho ML, Albors P, Cardenas F, Fuster E et al, Experience in the treatment (early vs delayed) of acute cholecystitis via laparoscopy. Cir Esp. 1999; 66:233
27. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L, Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003; 7(5):642–645
28. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004; 18(9):1323–1327
29. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998; 85(6):764–767
30. Lo CM, Liu CL, Fan ST, Lai EC, Wong J , Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998; 227(4):461–467
31. Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M et al , Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14(1):114–121
32. Schwesinger WH, Sirinek KR, Strodel WE , Laparoscopic cholecystectomy for biliary tract emergencies: state of the art. World J Surg. 1999; 23(4):334–342
33. Wiebke EA, Pruitt AL, Howard TJ, Jacobson LE, Broadie TA, Conversion of laparoscopic to open cholecystectomy.An analysis of risk factors". 1996;10(7):742-5
34. Abdulmohsen A. Al-Mulhim, early laparoscopic cholecystectomy, Inc. JSLS. 2008;12:282–287.
35. Muhmad Abdulla, department of surgery, al kadumia teaching hospital in Baghdad, early laparoscopic cholecystectomy versus delay laparoscopic cholecystectomy in acute cholecystitis, thesis of Iraqi board (2012).
36. Stavros G, Nikitas D, Stylianos G , Laparoscopic Cholecystectomy: a Safe Approach for Management of Acute Cholecystitis . JSLS. 2007;11:219–224
37. Reddick EJ, Olsen D, Spaw A, Safe performance of difficult laparoscopic cholecystectomies. Am J Surg. 1991; 161(3):377–381.
38. Dubois F, Levard H, Berthelot G, Mouro J, Karayel M. Complications of celioscopic cholecystectomy in 2006 patients. Ann Chir. 1994; 48(10):899 –904.
39. Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991; 213(6):665– 677.
40. Lujan JA, Parrilla P, Robles R, Martin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs. open cholecystectomy in the treatment of acute cholecystitis: Arch Surg. 1998; 133(2):173–175.
41. Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: World J Surg. 1997; 21(5):540 –545.
42. Zucker KA, Flowers JL, Bailey RW, Graham SM, Buell J, Imbembo AL. Laparoscopic management of acute cholecystitis. Am J Surg. 1993; 165(4):508 –514.
43. Rattner DW, Ferguson C, Warshaw AL. Factors associated with laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993; 217(3):233–236.
44. Chi-Leung Liu, Chung-Mau Lo, Edward C. S. Lai, Early Versus Delayed Laparoscopic Cholecystectomy for Treatment of Acute Cholecystitis. ANN SURG. 1996; 223(1):37-42
45. Bhattacharya D, Senapati PSP, Hurle R, Ammori BJ. Urgent versus interval laparoscopic cholecystectomy for acute cholecystitis: J Hepatobiliary Pancreat Surg. 2002; 9:538 –542.
46. Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed interval laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 2006; 20:82– 87.
47. Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP. Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc. 2000;14:358 –361.
48. Muhammad Najm Khan, Urgent cholecystectomy for acute cholecystitis, Ann R Coll Surg Engl 2009; 91: 30–34.
49. Peters JH, Krailadsiri W, Incarbone R, Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg. 1994; 168(6):555–559.
50. Lujan JA, Parrilla P, Robles R, Laparoscopic cholecystectomy the treatment of acute cholecystitis. J Am Coll Surg. 1995; 181(1):75- 77.
51. Bickel A, Rappaport A, Kanievski V, Laparoscopic surgery of acute cholecystitis. Prognostic factors for success. Surg Endosc. 1996; 10(11):1045–1049.
52. Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis.What is the optimal timing for operation? Arch Surg. 1996;
53. Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998;351:321–325.
54. Mercer SJ, Knight JS, Toh SKC, Walters AM, Sadek SA, Somers SS. Implementation of a specialist-led service for the management of acute gallstone disease. Br J Surg. 2004;91:504 –508.
55. Prakash K, Jacob G, Lekha V, Venugopal A, Venugopal B, Ramesh H. Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc. 2002;16:180 –183.
56. Nanez B, Mutter D, Russier Y. Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg. 2001;25:1352–1356.
57. Adamson S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg. 1997; 184: 571–8.
58. Cox M, Wilson T, Luck A, Jeans P, Padbury R, Toouli J. Laparoscopic cholecystectomy for the acute inflammation of the gall bladder. Ann Surg. 1993; 218: 630–4.
59. Madan AK, Aliabadi-Wahle S, Tesi D, Flint LM, Steinberg SM. How early is early laparoscopic treatment of acute cholecystitis? Am J Surg. 2002;183:232–236.
60. Garber SM, Korman J, Cosgrove JM, Cohen JR. Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 1997;11:347–350.
61. Wael N, Mikael P, Indu S, Yanling Ma, Parakrama C, Rodney J, Prediction of Patients with Acute Cholecystitis Requiring Emergent Cholecystectomy: Hindawi Publishing Corporation Gastroenterology :10.1155/2010/901739
Published
2018-02-08
How to Cite
HASSAN, H., ARIF, S., & AL-NAKSHABANDI, M. M. (2018). THE ROLE OF LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS. Duhok Medical Journal, 11(1), 69-81. Retrieved from http://dmj.uod.ac/index.php/dmj/article/view/8
Section
Articles
