B GÜNGÖR, A BAL, C. POLAT, K DİCLE, G SARP, K ERZURUMLU

Laparoskopik kolesistektomide açığa geçiş endikasyonları: Bir üniversite hastanesinin uzun dönem deneyimleri

Amaç: Laparoskopik kolesistektomi ameliyatında, intraoperatif ve postoperatif açık ameliyata geçilen hastaların incelenerek risk faktörlerinin ortaya konması amaçlanmıştır. Gereç ve Yöntem: Ekim 1993-Mart 2009 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda aynı ekip tarafından benign safra yolları hastalığı tanısıyla laparoskopik kolesistektomi uygulanan 647 hasta ve açık ameliyata geçilen 35’i, retrospektif olarak incelendi. Açık ameliyata geçiş endikasyonlarımız literatür bilgileri ışığında tartışıldı. Bulgular: Laparoskopik kolesistektomi planlanarak ameliyatına başlanılan 647 hastanın 35’inde (%5.4) erken veya geç dönemde laparotomiye geçilmek zorunda kalınmıştır. 647 hastanın 482‘si kadın, 165’i erkekti. Açık ameliyat gerektiren olgulardan 17’si erkek, 18’i kadındı. Açığa dönülen erkek ve kadın hastaların yaş ortalamaları arasında anlamlı fark yoktu (p=0.306). Ancak erkek hastalarda açığa geçiş oranı anlamlı olarak yüksekti (p=0.009). İlk 100 hastanın 9’unda açığa dönüş olmuşken (%9), sonraki hastalarda bu oran % 4.75 bulundu (p=0.137). En sık açık ameliyata geçiş nedenleri; mevcut akut kolesistite bağlı diseksiyon güçlüğü (13 olgu), geçirilmiş akut kolesistite bağlı yapışıklıklar (10 olgu), biliyer vasküler anomali (9 olgu) idi. Sonuç: Hastalarımızda en sık açığa geçiş nedenleri mevcut akut kolesistit ve geçirilmiş akut kolesistit atağına bağlı oluşan yapışıklıklar olarak bulundu. İlk 100 hastada açık ameliyata dönüş oranı daha yüksek idi. Erkek cinsiyetin açığa geçiş oranı, istatistiksel olarak anlamlı yüksek bulundu.

The indications of conversion to open surgery in laparoscopic cholecystectomy: A long term experience in an university hospital

Aim: The determination of the risk factors for the conversion of laparoscopic cholecystectomy to open surgery was aimed in this study. Material and Methods: The retrospective analysis of 647 patients operated on laparoscopic cholecystectomy was made. Thirty five patients were converted to open surgery. The indications for conversion to open surgery were discussed under the view of pertinent literature. Results: All of the 647 patients were planned to be operated on laparoscopic cholecystectomy. In 35 patients (5.4%), early or late open surgery (laparotomy) was needed.Four hundred and eigthy two patients were female, 165 were male. Seventeen patients converted to open surgery were male and 18 were female. There was no statistically significant difference in age between males and females who were converted to open surgery (p=0.306). But the rate of male patients converted to open surgery were significantly greater than the rate of females (p=0.009). In nine patients of first 100, open surgery was needed (9%); after first 100 patients the rate of conversion to open surgery became 4.5% (p=0.137). The most frequent indications for open surgery were difficult dissection related with ongoing and previous acute cholecystitis (13 cases), adhesions related with old attack of acute cholecystitis and biliary vascular anomalies (9 cases). Conclusion: The most frequent indications for conversion to open surgery in laparoscopic cholecystectomy were existing acute cholecystitis and adhesions related with previous acute cholecystitis. The conversion rates in first 100 cases were more than that of later cases related with the experience. Male patients had a significantly increased rate of conversion to open surgery.

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