title: Combined lower segment cesarean section and cholecystectomy in single sitting-our initial experience.
abstract: OBJECTIVE
  To study feasibility and results of cholecystectomy at the time of cesarean section.
  
  
  METHODS
  Thirty-two patients were subjected to cholecystectomy at cesarean section. Most of them were diagnosed with cholelithiasis at or before the first antenatal scan. Cholecystectomy was performed by subcostal mini-laparotomy, after assessing the anatomy via the cesarean wound.
  
  
  RESULTS
  Cholecystectomy was combined with lower segment cesarean section in all the patients. Under general anaesthesia, surgeries were performed with an mean duration of 90 minutes. Difficult anatomy at calots was found in 3 patients, who required extension of subcostal incision by 3-4 cm. One woman required blood transfusion during operation. There were no other intraoperative or postoperative complications. No extra antibiotics or analgesics doses were needed. Patients were discharged on 5(th)-7(th) postoperative day.
  
  
  CONCLUSIONS
  Combined cesarean section and cholecystectomy avoids rehospitalisation for separate cholecystectomy. With an additional small subcostal incision, single anaesthesia, and single hospital stay, the combined procedure confers valuable advantages for both patient and hospital in time, cost, and convenience, including avoiding the separation of mother from newborn entailed by reoperation. It also prevents the possibility of developing acute cholecystitis while the patient is waiting for cholecystectomy. Our results indicate that the combination approach is safe, effective, and well accepted.
authors.affiliation: Department of Surgery, Skims Mc Hospital, Bemina, Srinagar, Jammu and Kashmir, India.
authors.forename: Majid
authors.initials: M
authors.lastname: Mushtaque
authors.affiliation: Department of Health&Family Welfare, Jammu and Kashmir, India.
authors.forename: Ibrahim R
authors.initials: IR
authors.lastname: Guru
authors.affiliation: Department of Health&Family Welfare, Jammu and Kashmir, India.
authors.forename: Tajamul N
authors.initials: TN
authors.lastname: Malik
authors.affiliation: Department of Health&Family Welfare, Jammu and Kashmir, India.
authors.forename: Samina A
authors.initials: SA
authors.lastname: Khanday
keywords: Lower segment cesarean section (LSCS); cholecystectomy; combined approach; gall bladder disease; pregancy