İLK 416 LAPAROSKOPİK KOLESİSTEKTOMİ OLGULARIMIZIN ANALİZİ

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Anahtar Kelimeler:

Laparoskopik kolesistektomi

Analysis Of Our First 416 Laparoscopic Cholecystectomy Cases

Purpose: The aim of this study is to evaluate the first 416 cases of laparoscopic cholecystectomy (LC) performed in the General Surgery Department of Adnan Menderes University Medical School. Patients and Methods: The data obtained from the LC cases between August 1997 and January 2001 were analysed retrospectively. Results: The sex distribution of the cases was 335 (80.5 %)femaleand81 (19.5 %)male (F/M: 4.1). Medianage was 51.2 years (range: 18-82), median operative time was 79.2 minutes (range: 17-330). Indications for surgery were chronic cholecystitis in 393 (94.5 %), acute cholecystitis in16 (3.8 %), andgallbladderpolyps in7 (1.7 %). History ofupperabdominal surgery was present in 9 (2.2 %) and lower abdominal surgery in 37 (8.9 %) patients. Overall, conversion to open laparotomy was necessary in 15 patients due to (adhesions in 3, bleeding in 2, biliary duct injury in 2 and malignancy in 1) and intraoperative complications occured in 53 (12.7 %) patients (37 gall bladder perforation, 10 bleeding, 3 biliary duct injury, 1 intestinal perforation and 3 technical problems). Four patients (1 %) required reoperation due to complications (bleeding in 2, biliary duct injury in 1 and intestinal injury in 1). Overall morbidity rate was 14.9 % and there was no mortality. Median postoperative hospital stay was 1.6 days (8 hours-28 days). Conclusion: LC was applied to all patients who had cholelithiasis in our clinic. Acute cholecystitis seems to be the main factor increasing the ratio of conversion to open cholecystectomy. However, LC should be the first choice for all cases with cholelithiasis.

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  • 1. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW . Laparoscopic cholecystectomy. The new "gold standard"? Arch Surg 1992 ; 127: 917-21.
  • 2. NIH consensus conference statement on gallstones and laparoscopic cholecystectomy. Am J Surg 1993;165: 390-8.
  • 3. Sayek Ý, Öner Z, Özdemir A ve ark. Ýlk 200 laparoskopik kolesistektomi olgusunun deðerlendirilmesi. Klinik ve Deneysel Cerrahi Dergisi 1993;1:209-12.
  • 4. Troidl H, Spangenberger W, Langen R et al. Laparoscopic cholecystectomy: technical performance, safety and patient's benefit. Endoscopy 1992; 24: 252-61.
  • 5. Steele RJ, Marshall K, Lang M, Doran J. Introduction of laparoscopic cholecystectomy in a large teaching hospital: independent audit of the first 3 years. Br J Surg 1995; 82: 968-71.
  • 6. Croce E, Azzola M, Golia M, Russo R, Pompa C. Laparocholecystectomy. 6865 cases from Italian institutions. Surg Endosc 1994; 8: 1088-91.
  • 7. Kramling HJ, Hüttl TP, Geberer G. Development of gallstone surgery in Germany. Surg Endosc 1999; 13: 909-13.
  • 8. Cuschieri A, Berci G, McSherry CK. Laparoscopic cholecystectomy (Editorial). Am J Surg 1990; 159: 273.
  • 9. Schirmer BD, Edge BS, Dix J et al. Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis. Ann Surg 1991; 213: 665-76.
  • 10. Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP. Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc 2000; 14: 358-61.
  • 11. Poole GH, Yellapu S. Acute laparoscopic cholecystectomy. Surg Endosc 2000; 14:106-9.
  • 12. Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S. Laparoscopic cholecystectomy for acute cholecystitis: Can the need for conversion and the probability of complications be predicted? Surg Endosc 2000; 14: 755-60.
  • 13. Curet MJ. Special problems in laparoscopic surgery: Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000; 80: 1093-1111.
  • 14. Wiebke EA, Pruitt AL, Howard LE, et al: Conversion of laparoscopic to open cholecytectomy: An analysis of risk factors. Surg Endosc 1996; 10: 742-5.
  • 15. Buðra D, Yamaner S, Þahin A ve ark. Laparoskopik kolesistektomi ( 483 vakanýn deðerlendirilmesi ). Klin Deney Cerrah Derg 1997; 5: 1-6.
  • 16. Usal H, Sayad P, Hayek N, Hallak A, Huie F, Ferzli G. Major vascular injuries during laparoscopic cholecystectomy. Surg Endosc 1998; 12: 960-2.
  • 17. Geers J, Holden C. Major vascular injury as a complication of laparoscopic surgery: a report of three cases and review of the literatüre. Am J Surg 1996; 62: 377-9.
  • 18. Rickman A, Kistner RL, Schlinkert RT. Complet abdominal exploration is unnecassary during the treatment of cholelithiasis. J Laparoendosc Surg 1993; 3:205-8.
  • 19. Majeed AW, Reed MW, Hall J, Ross B, Johnson AG. The value of abdominal exploration during cholecystectomy. J R Coll Surg Edinb 1995; 40: 377-9.
  • 20. Gal I, Szivos J, Jaberansari MT, Szabo Z. Laparoscopic cholecystectomy: Risk of missed pathology of other organs. Surg Endosc 1998; 12: 825-7.
  • 21. Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 1997; 184: 571-8.
  • 22. Regöly-Merei J, Ihasz M, Szeberin Z, Sandor J, Mate M. Biliary tract complications in laparoscopic cholecystectomy: A multicenter study of 148 biliary tract injuries in 26.440 operations. Surg Endosc 1998; 12: 294-300.
  • 23. Woods MS, Traverso LW, Kozarek RA, et al. Characteristics of biliary tract complications during laparoscopic cholecystectomy: a multi-institutional study. Am J Surg 1994; 167: 27-33.
  • 24. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993; 165: 9-14.
  • 25. Z'graggen K, Wehrli H, Metzger A, Buehler M, Frei E, Klaiber C. Complications of laparoscopic cholecystectomy in Switzerland: A prospective 3-year study of 10,174 patients. Surg Endosc 1998; 12:1303- 10.
  • 26. Scott TR, Zucker KA, Bailey RW. Laparoscopic cholecystectomy: a review of 12,397 patients. Surg Laparosc Endosc 1992; 2: 191-8.
  • 27. Schafer M, Suter C, Klaiber Ch, Wehrli H, Frei E, Krahenbühl L. Spilled gallstones after laparoscopic cholecystectomy: A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc 1998; 12: 305-9.
  • 28. Memon MA, Deeik RK, Maffi TR, Fitzgibons Jr RJ. The outcome of unretrieved gallstones in the peritoneal cavity during laparoscopic cholecystectomy. Surg Endosc 1999; 13: 848-57.
  • 29. Targarona EM, Balague C, Cifuentes A, Martinez J, Trias M. The spilled stone. A potential danger after laparoscopic cholecystectomy. Surg Endosc 1995; 9: 768-73.