Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri

Amaç: Hastanemiz genel cerrahi kliniğinde yapılan laparoskopik kolesistektomi girişimlerinin demografik özelliklerinin saptanması, açık ameliyata geçiş oranının belirlenmesi, açığa geçiş nedenlerinin ortaya konması hedeflenmiştir. Yöntem: Hastanemizde Eylül 2008- Agustos 2013 yılları arasında yapılan 568 laparoskopik kolesistektomi girişiminin kayıtları incelendi. Yaş ve cinsiyetleri, açığa geçiş nedenleri, akut kolesistit ve kronik kolelitiyazis olguları, yaş gruplarına göre açığa geçiş oranları belirlendi. Bulgular: Olgularımızın 525’ i kadın (% 92.4),43’ü erkektir (% 7.6), kadın/erkek oranı 12.1 idi. Ortalama yaş 45.5 ± 12.7 (18-82), ortalama ameliyat süresi 60.2 (17-200 ) dakika idi. ameliyat endikasyonları; 525 hasta kolelitiyazis (% 92.4), 33 hastanın akut kolesistit (% 4.4) ve 6 hastanın safra kesesi polibi (% 1). 2 hastanın akalkülöz kolesistit (% 0.35) nedeni ile opere olmuştu. Olgularımızın 20’sinde(% 3.5) açığa geçilmiş, 10 olguda (% 1.2) olguda intraoperatif komplikasyonlar gelişmişti. Mortalite yoktur. Hastanede yatış ortalama süresi 1.6 gündür (8 saat-26 gün). Açığa geçiş nedenleri; Calot üçgeninde yapışıklık (3 hasta), akut kolesistit (33 hasta), koledok taşı (2 hasta), geçirilmiş ameliyata bağlı yapışıklıklar (1 hasta), diseksiyon güçlüğü (2 hasta), organ yaralanması (2 hasta), anatomik varyasyon (1 hasta), taş dökülmesi (1hasta), olarak belirlendi. Sonuç: Laparakopik kolesistektomide açığa geçişi arttıran en önemli faktör akut kolesistit gibi görünmektedir. Erkek cinsiyet, ileri yaş ve akut kolesistit halinin açık ameliyata geçiş riskini arttıran faktörler olduğu saptandı. Buna rağmen ilk tercih edilecek girişim şekli laparakopik kolesistektomi olmalıdır. The reasons of conversion to open surgery in laparoscopic cholecystectomy SUMMARY Purpose: To determine the number of laparoscopic cholecystectomy procedures, reasons and risk factors for conversion to open cholecystectomy, which were performed in the General Surgery Department of our Hospital. Methods: 568 laparoscopic cholecystectomy procedures performed between 2008-2013 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: The sex distribution of the cases was 525 (92.4%)and 43 (7.6 %) male (F/M: 4.1). Median age was 45.5 ± 12.7 years (range: 18-82), median operative time was 60.2 minutes (range: 17-200). Indications for surgery, were chronic cholecystitis in 525 (92.4 %), acute cholecystitis in33 (4.4 %), and gallbladder polyps in 6 (1 %). acalculo cholecystitis in 2patient(% 0.35) were operated. Overall, conversion to open laparotomy was necessary in 20 patients(3.5%) Seven patients (1.2 %) required reoperation due to complications .There was no mortality. Median postoperative hospital stay was 1.6 days (8 hours-28 days). Causes of conversion were determined as fibrosis in Calot’s triangle (n=3), acute cholecystitis (n=33), stone in choledocus (n=2), adhesions due to previous operations (n=1), difficulty in dissection (n=2), organ injury (n=2), anatomical variation (n=1), perforation of gallbladder and seeding of stones into abdominal cavity (n=1).Conclusion: Acute cholecystitis seems to be the main factor increasing the ratio of conversion to open cholecystectomy. Risk factors of conversion to open cholecystectomy were determined as follows: male gender, being elderly and the diagnosis of acute cholecystitis before the operation. However, laparoscopic cholecystectomy should be the first choice for all cases with cholelithiasis.

Anahtar Kelimeler:

Laparoskopik kolesistektomi, açık kolesistektomi, komplikasyonlar

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Aim To determine the number of laparoscopic cholecystectomy procedures, reasons and risk factors for conversion to open cholecystectomy, which were performed in the General Surgery Departmnent of our Hospital. Materials and Methods 568 laparoscopic cholecystectomy procedures performed between 2008-2013 were analyzed. Patients’ age andsex were noted. The causes of conversion to open cholecystectomy, the number of acute cholecytitis and chronic cholelithiasis cases, conversion rates according to the age groups were determined. Results The sex distribution of the cases was 525 (92.4%) and 43 (7.6 %) male (F/M: 4.1). Median age was45.5 ± 12.7 years , median operative time was 60.2 minutes . Indications for surgery, were chronic cholecystitis in 525 (92.4 %), acute cholecystitis in 33 (4.4 %), and gall bladder polyps in 6 (1 %), a calculous cholecystitis in 2patient (% 0.35) were operated. Overall, conversion to open laparotomy was necessary in 20 patients (3.5%) Seven patients (1.2 %) required reoperation due to complications.There was no mortality. Median post operative hospital stay was1.6 days (8 hours28 days). Causes of conversion were determined as fibrosis in Calot’striangle (n=3), acute cholecystitis (n=33), stone in choledocus (n=2), adhesions due to previous operations (n=1), difficulty in dissection (n=2), organ injury (n=2), anatomical variation (n=1), perforation of gall bladder and seeding of Stones into abdominal cavity (n=1).Conclusion Acute cholecystitis seems to be the main factorin creasing the ratio of conversion to open cholecystectomy. Risk factors of conversion to open cholecystectomy were determined as follows: male gender, being elderly and the diagnosis of acute cholecystitis before the operation. However, laparoscopic cholecystectomy should be the first choice for all cases with cholelithiasis

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