M. Recep PEKCİCİ, Mehmet İNCEKÖY, Veli TORUN, A. Bülent CANLI

SSK Konya Bölge Hastanesinde laparoskopik kolesistektomi deneyimi ve açık ameliyata geçme nedenleri

Amaç: SSK Konya Bölge Hastanesinde yapılan laparoskopik kolesistektomi girişimlerinin demografik özelliklerinin saptanması, açık ameliyata geçiş oranının belirlenmesi, açığa geçiş nedenlerinin ortaya konması. Açık ameliyata geçişte etkili olabilecek faktörlerin irdelenmesi. Yöntem: Hastanemizde 1995–2003 yılları arasında yapılan 4861 laparoskopik kolesistektomi girişiminin kayıtları incelendi. Yaş ve cinsiyetleri, açığa geçiş nedenleri, akut kolesistit ve kronik kolelityazis olguları, yaş gruplarına göre açığa geçiş oranları belirlendi. Bulgular: Hastaların 3978’i (% 81.8) kadın, 883’ü (% 18.2) erkekti. Kadınların yaş ortalaması 47.9 ± 12.3, erkeklerin yaş ortalaması 51.3 ± 12.4 ve genel yaş ortalaması 48.5 ± 12.7 yıl idi. Toplam 244 hastada (% 5) açık ameliyata geçildiği saptandı. Açığa geçiş nedenleri; Calot üçgeninde yapışıklık (80 hasta), akut kolesistit (49 hasta), kanama (26 hasta), koledok taşı (13 hasta), geçirilmiş ameliyata bağlı yapışıklıklar (13 hasta), diseksiyon güçlüğü (12 hasta), organ yaralanması (10 hasta), anatomik varyasyon (9 hasta), malignite şüphesi (6 hasta), teknik yetersizlik (6 hasta), taş dökülmesi (4 hasta), diğer nedenler (16 hasta) olarak belirlendi. Sonuç: Çalışmada toplam açık ameliyata geçiş oranı % 5 olarak saptandı. En sık açığa geçiş nedenleri Calot üçgeninde yapışıklık, akut kolesistit ve kanama olarak belirlendi. Erkek cinsiyet, ileri yaş ve akut kolesistit halinin açık ameliyata geçiş riskini arttıran faktörler olduğu saptandı.

Anahtar Kelimeler:

Tıbbi kayıtlar, Geriyedönük çalışma, Kolesistektomi, laparoskopik, Yaş dağılımı, Cinsiyet dağılımı, Kolesistit, akut

Laparoscopic cholecystectomy experience and the reasons of conversion to open cholecystectomy at Konya Hospital of Social Securities

Objective: To determine the number of laparoscopic cholecystectomy procedures, reasons and risk factors for conversion to open cholecystectomy, which were performed at Konya Hospital of Social Securities Institution. Methods: 4861 laparoscopic cholecystectomy procedures performed between 1995 and 2003 were analyzed. Patients’ age and sex were noted. The causes of conversion to open cholecystectomy, the number of acute cholecystitis and chronic cholelithiasis cases, conversion rates according to the age groups were determined. Results: There were 3978 women (81.2%) and 883 men (18.2%). Median ages of women, men and general patient population were 47.9 years, 51.3 years and 48.5 years, respectively. Conversion to open cholecystectomy was needed in 244 (5%) patients. Causes of conversion were determined as fibrosis in Calot’s triangle (n=80), acute cholecystitis (n=49), bleeding (n=26), stone in choledocus (n=13), adhesions due to previous operations (n=13), difficulty in dissection (n=12), organ injury (n=10), anatomical variation (n=9), suspected malign disease (n=6), technical problems (n=6), perforation of gallbladder and seeding of stones into abdominal cavity (n=4), other causes (n=16). Conclusion: Total conversion rate to open cholecystectomy was 5%. Most common causes of conversion were fibrosis in Calot’s triangle, acute cholecystitis and bleeding. Risk factors of conversion to open cholecystectomy were determined as follows: male gender, being elderly and the diagnosis of acute cholecystitis before the operation.

Keywords:

Medical Records, Retrospective Studies, Cholecystectomy, Laparoscopic, Age Distribution, Sex Distribution, Cholecystitis, Acute,

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