Murat AKIN, Bülent SALMAN, Mustafa ŞARE, Cem AZILI, Utku YILMAZ, Tugan TEZCANER, Ertan TATLICIOĞLU

Laparoskopik kolesistektomiden açık kolesistektomiye dönülen hastalarda preoperatif risk faktörleri ve intraoperatif nedenler: 536 hastanın retrospektif analizi

Amaç: Kolelitiazis hastalarında laparoskopik kolesistektomi (LK) altın standart bir tedavi yöntemi olmakla beraber açık ameliyata dönüş riski bulunmaktadır. Bu çalışmanın amacı LK’dan açık kolesistektomiye dönüş (LKAD) nedenlerini incelemek ve açığa geçişteki faktörleri değerlendirmektir. Hastalar ve Yöntem: Gazi Üniversitesi Tıp Fakültesi Hastanesinde 2002 Mayıs ve 2006 Mayıs tarihleri arasında LK yapılan ve kayıtları incelenen 536 hasta çalışmaya dahil edildi. Hastalar LK yapılanlar (grup 1, n = 492) ve laparoskopik kolesistektomiden açık ameliyata dönülenler (grup 2, n = 44) olarak iki gruba ayrıldı. Gruplarda yer olan hastaların demografik özellikleri [yaş, cinsiyet, vücut kitle indeksi (BMI-), ASA (American Society of Anesthesiology) skorları] klinik hikayeleri, geçirilmiş abdominal ameliyatları, preoperatif laboratuar, abdominal ultrasonografi ve endoskopik retrograd kolanjiyopankreatikografi (ERCP) sonuçları, intraoperatif bulguları retrospektif olarak risk faktörleri açısından değerlendirildi. Bulgular: Toplam 536 hastanın 44’ünde (%8.3) açık ameliyata dönüldüğü tespit edildi. LK grubunda yaş ortalaması 49.5±12.6, LKAD grubunda 52.7±15.6 olarak tespit edildi (P> 0.05). Preoperatif beyaz küre yüksekliği, abdominal ultrasonografi incelemesinde safra kesesi kalınlığında artma (≥ 5 mm) ve perikolesistik sıvı varlığı açık ameliyata dönüşte prediktif faktörler olarak belirlendi. İntraoperatif değerlendirmede yüksek adezyon skoru (grade IV), Callot diseksiyonunda zorluk, akut kolesistit görünümü ve kanama açık ameliyata dönüş nedenleri olarak tespit edildi. Sonuç ve Tartışma: Cerrah, preoperatif ve özellikle intraoperatif riski artıran durumları iyi değerlendirmeli ve bunların varlığında ameliyatın hazırlık aşamasından itibaren ameliyatın sağlıklı şekilde yapılabilmesi için gerekeni sağlamalıdır

Preoperative risk factors and intraoperative reasons for conversion of laparoscopic to open cholecystectomy: retrospective analysis of 536 cases

Purpose: Although laparoscopic cholecystectomy (LC) is the gold standard treatment modality for cholelithiasis, there is still a risk of conversion to open cholecystectomy. The aim of this study was to evaluate the reasons for conversion from LC to open cholecystectomy (LCOC) and investigate the risk factors. Patients and Methods: A total of 536 patients who had been operated on for cholelithiasis in Gazi University School of Medicine between May 2002 and May 2006 and whose data were available were enrolled in the study. Patients were grouped as group 1 (n = 492), which was composed of patients who had undergone LC, and group 2 (n = 44), which was composed of patients who had undergone LCOC. Patients were retrospectively evaluated according to their demographic characteristics [age, sex, body mass index (BMI)) ASA (American Society of Anesthesiology] scores, clinical histories, previous abdominal operations, preoperative laboratory findings, abdominal ultrasonography (US), preoperative endoscopic retrograde cholangiopancreaticography (ERCP), and intraoperative findings. Results: LCOC had been performed in 44 patients (8.3%). Mean age was 49.5±12.6 in the LC group and 52.7±15.6 in the LCOC group (P> 0.05). Preoperative high levels of white blood cells, increased gall bladder wall thickness (≥ 5 mm), and the existence of pericholecystic fluid in abdominal US were the predictive factors for LCOC. High adhesion score (grade IV), difficulty in Callot dissection, appearance of acute cholecystitis, and bleeding were the intraoperative reasons for LCOC. Conclusion: LCOC is not regarded as a complication. The surgeon has to manage the operation plan evaluating the preoperative and especially intraoperative factors.

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