Fahri YILMAZ, Mehmet Levhi AKIN, Kazım DUMAN, Koray Halil SEZER

The clinical outcome of traditional laparoscopic cholecystectomy

Morbiditesi %0,1 lere kadar indirilen, düşük volümlü hastanelerde uygulanabilen, ciddi komplikasyonları ancak tecrübeli cerrahlarca tedavi edilen geleneksel LK tecrübelerimizi, komplikasyonlarımızı, ne seviyede olduğumuzu görmeyi ve paylaşmayı amaçladık. Ocak 2008- Haziran 2011 tarihleri arasında 3 ayrı merkezde, 3 ayrı laparoskopik tecrübeleri birbirine yakın cerrah tarafından elektif şartlarda yapılan Laparoskopik Kolesistektomi olgularının pre-intra-post operatif bulgularına ulaşılarak, demografik verileri, operasyon endikasyonları, operasyon şekli (port sayısı, süresi), daha önce operasyon geçirip geçirmediği, Sistemik bir hastalığı olup olmadığı, hastanede yatma süreleri, açığa dönüş sebepleri, ERCP yapılıp yapılmadığı, görülen komplikasyonlar retrospektif olarak incelendi. 165 (%72.6) i kadın, 101 (%27.4) i erkek 266 hasta dosyası retrospektif olarak incelendi. Yaş ortalaması 42.6 yıl (range:24-72) idi. Ortalama operasyon süresi 45 dakika (range:30-75) bulundu. 71 (%26.7) hastada 3 port, 195 (%73,3) hasta 4 port kullanılarak operasyon gerçekleştirildi. 25 (%9.4) hastaya batın içi dren kondu. 5 (%9.4) hastaya preoperatif olarak ERCP yapılmış, 6 (%2.3) hasta daha önce üst batın, 31(%11.7) hasta da alt batın operasyonu geçirmiş olduğu bulundu. 6 (%2.3) hastada kanama, 4 hastada (%1.5) anatominin ortaya konamaması (anatomik uyumsuzluk), 3 hastada (%1.1) yapışıklık ve zor teknik şartlar sebebiyle açık kolesistektomiye dönüldü. Gerekli hasta seçimi ile sorunsuz olarak, düşük volümlü hastanelerde laparoskopik kolesistektomi işlemi gerçekleştirilebilir. Komplikasyon durumunda multidisipliner yaklaşımın ön planda tutulması, hasta morbidite ve mortalitesi açısından daha faydalı olacağı kanaatindeyiz.

Geleneksel laparoskopik kolesistektomi klinik sonuçlarımız

Laparoscopic cholecystectomy is a safety, efficacy,established method for the treatment of symptomatic gallstone disease. We aim to share traditional laparoscopic cholesistectomy experience and complications that treated with experienced surgeons in low-volume hospitals. This study was performed during the period of 2009- 2011 in three hospital. We analyzed retrospectively 266 patients, who were operated elective by three surgeon whose experiences were closely. We compared demographic data, patients age, gender, number of ports, operation time, length of hospital stay, whether or not previous abdominal surgery, whether or not systemic disease, whether or not has been performed ERCP, reason of converted from laparoscopic to open cholecystectomy and complications. 266 [165 (%72,6) female and 101 (%27,4) male] patients evaluated retrospectively. The average age was 42,6 (range 27-42). The average duration of operation was 45 minutes (range 35-72). The operation was performed by using four ports in 195 (73,3%) patients and by using three ports in 71 (26,7%) patients. 25 (9,4%) patients had intra-abdominal drainage. ERCP was performed preoperatively in 5 (9,4%) patients. We convert open cholecystectomy in6 (2,3%) patients, due to bleeding, in 4 patients (1,5%) due to anatomical mismatch, 3 patients (1,1%) due to adhesions and difficult technical conditions. Laparoscopic cholecystectomy can be performed seamlessly with appropriate patient selection in low-volume hospitals, We believe that multidisciplinary approach was a priority in case with complications, it will be useful in terms of patient morbidity and mortality.

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