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Year 2014, Volume: 2 Issue: 1, 8 - 13, 27.10.2015

Selim Sözen , Seyfi Emir , İlhan Bali

Abstract

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

Keywords

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References

  • Troidl H, Spangenberger W, Langen R et al. Laparoscopic cholecystectomy: technical performance, safety and patient's benefit. Endoscopy 1992; 24: 252- 61.
  • Kramling HJ, Hüttl TP, Geberer G. Development of gallstonesurgery in Germany. SurgEndosc 1999; 13: 909-13.
  • Daniel BJ, Nathaniel JS. Complications of laparoscopic cholecystectomy. Ann Rev Med 1996; 47: 31-44.
  • SouthernSurgeons Club. A prospectiveanalysis of 1518 laparoscopic cholecystectomies. N Engl J Med 1991;324: 1073- 8. 5.
  • Cuschieri A, Berci G, McSherry CK. Laparoscopic cholecystectomy (Editorial). Am J Surg 1990; 159: 273.
  • Schirmer BD, Edge BS, Dix J et al. Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis. Ann Surg 1991; 213: 665-76.
  • Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nation wide series. J AmColl Surg 1997; 184: 571-8. 8.
  • 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. 9.
  • Lein HH, Huang CS. Male gender: risk factor for severe symptomatic cholelithiasis. World J Surg 2002;26:598-601.
  • Kaushik R, Sharma R, Batra R, Yadav TD, Attri AK, Kaushik SP. Laparoscopic cholecystectomy: an Indian experience of 1233 cases. J laparoendosc Adv SurgTech A 2002;12:21-5.
  • Curet MJ. Special problems in laparoscopic surgery: Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am2000; 80: 1093-1111.
  • Deizel DD, Millikan KW, Economou SG, Doolas A, Ko ST, Arian MC. Complications of laparoscopic cholecystectomy: A national survey of 4292 hospitals and analysis of 77604 cases. Am J Surg 1993;165:9- 14.
  • Cuschieri A, Dubois NF, Mouiel J. The European experiences with laparoscopic cholecystectomy. Am J Surg 1991; 161: 385-7.
  • Shurkalin BK, Kriger AG, Gorskii VA, Ovanesian ER, Andreistev IL, Rzhebaev KE. Complications of laparascopic cholecystectomy. Vestn KhirIm I I Grek 2001;160:78-83.
  • Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, Hinchey EJ, Meakins JL. Factors determining conversion to laparotomy in patients under going laparoscopic cholecystectomy. Am J Surg 1994; 167:35-41.
  • Unger SW, Rosenbaum G, Unger HM, Edelman DS. A comparison
  • acutecholecystitis. SurgEndosc 1993;7:408-11.
  • Göçmen E, Doğanay M, Karaayvaz M, Kama NA. Laparoskopikkolesistektomi: ilk 150 hastadaki erken
  • of sonuçlarımız. T KlinGastroenterohepatol 1995;6:132-6. 18. Cates JA, Tompkins RK, Zinner MJ, Busuttil RW, Kolmann C, Roslyn JJ. Biliarycomplications of laparoscopiccholecystectomy. Am Surg 1993;59:243- 7.
  • Chi-leungLiu, Sheung-tat F, Edward CSL, Chung-mau L, Kentman C. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. ArchSurg 1996; 131:98-101.
  • Nielsen LB, Harboe KM, Bardram L. Cholecystectomy for the elderly: no hesitation for other wise healthy patients. SurgEndosc. 2013 Aug 31. [Epubahead of print]
  • Vecchio R, MacFadyen BV, Latteri S. Laparoscopic cholecystectomy: an analysis on 114,005 cases of United Statesseries. IntSurg 1998;83:215-9.
  • Keskin A, Bostano_lu S, Atalay F, Elbir O, Seven C, Arda K. Laparoskopik kolesistektomide laparotomiye konversiyon. End.- Lap. ve Minimal invaziv Cerrahi 1996;3:107-10. 23. Miller RE, Kimmelstiel FM.
  • Laparoscopic cholecystectomy for acute cholecystitis. SurgEndosc 1993;7:296-9.
  • Alabaz Ö, Sönmez H, Erkoçak EU, Camcı C, Dalyan O. Laparoskopik kolesistektomi:192 olgunun sunumu. End.-Lap. Ve Minimal invaziv Cerrahi 1996;3:94-9.
  • De Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, Nathens AB. Comparative Operative
  • Cholecystectomy for Acute Cholecystitis: A Population- Based Propensity Score Analysis.AnnSurg. 2013 Aug 23. [Epubahead of print] Early and
  • Delayed 26. Shamiyeh A, Wayand W.
  • Laparoscopic cholecystectomy: early and late complications and their treatment. LangenbecksArchSurg 2004;389:164- 71.
  • Balija M, Huis M, Szerda F, Bubnjar J, Stulhofer M. Laparoscopiccholecystectomy-accessory bile ducts. ActaMedCroatica 2003;57:105-9.
  • Özgen A, Akata A, Arat FB, Demirkazık M, Özmen N, Akhan O.
  • Gallbladderduplication: imagingfindingsanddifferentialconsideraions.
  • AbdomImaging 1999; 24:285-288.
  • Dahnert W. RadiologyReview Manual. 2nd ed. Williams&Wilkins 1993; 426. S, 30. Gupta Kumar A, Gautam
  • A. Preoperativesonographicdiagnosis of gall baldder duplication: importance of challenge with fatty meal. J ClinUltrasound 1993; 21:399-401.
  • Hobby JAE: Bilobedgallbladder. Br J Surg 1970; 57:870.

Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri

Year 2014, Volume: 2 Issue: 1, 8 - 13, 27.10.2015

Selim Sözen , Seyfi Emir , İlhan Bali

Abstract

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.

Keywords

Laparoskopik kolesistektomi açık kolesistektomi komplikasyonlar

References

  • Troidl H, Spangenberger W, Langen R et al. Laparoscopic cholecystectomy: technical performance, safety and patient's benefit. Endoscopy 1992; 24: 252- 61.
  • Kramling HJ, Hüttl TP, Geberer G. Development of gallstonesurgery in Germany. SurgEndosc 1999; 13: 909-13.
  • Daniel BJ, Nathaniel JS. Complications of laparoscopic cholecystectomy. Ann Rev Med 1996; 47: 31-44.
  • SouthernSurgeons Club. A prospectiveanalysis of 1518 laparoscopic cholecystectomies. N Engl J Med 1991;324: 1073- 8. 5.
  • Cuschieri A, Berci G, McSherry CK. Laparoscopic cholecystectomy (Editorial). Am J Surg 1990; 159: 273.
  • Schirmer BD, Edge BS, Dix J et al. Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis. Ann Surg 1991; 213: 665-76.
  • Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nation wide series. J AmColl Surg 1997; 184: 571-8. 8.
  • 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. 9.
  • Lein HH, Huang CS. Male gender: risk factor for severe symptomatic cholelithiasis. World J Surg 2002;26:598-601.
  • Kaushik R, Sharma R, Batra R, Yadav TD, Attri AK, Kaushik SP. Laparoscopic cholecystectomy: an Indian experience of 1233 cases. J laparoendosc Adv SurgTech A 2002;12:21-5.
  • Curet MJ. Special problems in laparoscopic surgery: Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am2000; 80: 1093-1111.
  • Deizel DD, Millikan KW, Economou SG, Doolas A, Ko ST, Arian MC. Complications of laparoscopic cholecystectomy: A national survey of 4292 hospitals and analysis of 77604 cases. Am J Surg 1993;165:9- 14.
  • Cuschieri A, Dubois NF, Mouiel J. The European experiences with laparoscopic cholecystectomy. Am J Surg 1991; 161: 385-7.
  • Shurkalin BK, Kriger AG, Gorskii VA, Ovanesian ER, Andreistev IL, Rzhebaev KE. Complications of laparascopic cholecystectomy. Vestn KhirIm I I Grek 2001;160:78-83.
  • Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, Hinchey EJ, Meakins JL. Factors determining conversion to laparotomy in patients under going laparoscopic cholecystectomy. Am J Surg 1994; 167:35-41.
  • Unger SW, Rosenbaum G, Unger HM, Edelman DS. A comparison
  • acutecholecystitis. SurgEndosc 1993;7:408-11.
  • Göçmen E, Doğanay M, Karaayvaz M, Kama NA. Laparoskopikkolesistektomi: ilk 150 hastadaki erken
  • of sonuçlarımız. T KlinGastroenterohepatol 1995;6:132-6. 18. Cates JA, Tompkins RK, Zinner MJ, Busuttil RW, Kolmann C, Roslyn JJ. Biliarycomplications of laparoscopiccholecystectomy. Am Surg 1993;59:243- 7.
  • Chi-leungLiu, Sheung-tat F, Edward CSL, Chung-mau L, Kentman C. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. ArchSurg 1996; 131:98-101.
  • Nielsen LB, Harboe KM, Bardram L. Cholecystectomy for the elderly: no hesitation for other wise healthy patients. SurgEndosc. 2013 Aug 31. [Epubahead of print]
  • Vecchio R, MacFadyen BV, Latteri S. Laparoscopic cholecystectomy: an analysis on 114,005 cases of United Statesseries. IntSurg 1998;83:215-9.
  • Keskin A, Bostano_lu S, Atalay F, Elbir O, Seven C, Arda K. Laparoskopik kolesistektomide laparotomiye konversiyon. End.- Lap. ve Minimal invaziv Cerrahi 1996;3:107-10. 23. Miller RE, Kimmelstiel FM.
  • Laparoscopic cholecystectomy for acute cholecystitis. SurgEndosc 1993;7:296-9.
  • Alabaz Ö, Sönmez H, Erkoçak EU, Camcı C, Dalyan O. Laparoskopik kolesistektomi:192 olgunun sunumu. End.-Lap. Ve Minimal invaziv Cerrahi 1996;3:94-9.
  • De Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, Nathens AB. Comparative Operative
  • Cholecystectomy for Acute Cholecystitis: A Population- Based Propensity Score Analysis.AnnSurg. 2013 Aug 23. [Epubahead of print] Early and
  • Delayed 26. Shamiyeh A, Wayand W.
  • Laparoscopic cholecystectomy: early and late complications and their treatment. LangenbecksArchSurg 2004;389:164- 71.
  • Balija M, Huis M, Szerda F, Bubnjar J, Stulhofer M. Laparoscopiccholecystectomy-accessory bile ducts. ActaMedCroatica 2003;57:105-9.
  • Özgen A, Akata A, Arat FB, Demirkazık M, Özmen N, Akhan O.
  • Gallbladderduplication: imagingfindingsanddifferentialconsideraions.
  • AbdomImaging 1999; 24:285-288.
  • Dahnert W. RadiologyReview Manual. 2nd ed. Williams&Wilkins 1993; 426. S, 30. Gupta Kumar A, Gautam
  • A. Preoperativesonographicdiagnosis of gall baldder duplication: importance of challenge with fatty meal. J ClinUltrasound 1993; 21:399-401.
  • Hobby JAE: Bilobedgallbladder. Br J Surg 1970; 57:870.
There are 36 citations in total.

Details

Primary Language Turkish
Journal Section Araştırma Makaleleri
Authors

Selim Sözen

Seyfi Emir

İlhan Bali This is me

Publication Date October 27, 2015
Published in Issue Year 2014 Volume: 2 Issue: 1

Cite

APA Sözen, S., Emir, S., & Bali, İ. (2015). Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri. International Journal of Basic and Clinical Medicine, 2(1), 8-13.
AMA Sözen S, Emir S, Bali İ. Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri. International Journal of Basic and Clinical Medicine. October 2015;2(1):8-13.
Chicago Sözen, Selim, Seyfi Emir, and İlhan Bali. “Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri”. International Journal of Basic and Clinical Medicine 2, no. 1 (October 2015): 8-13.
EndNote Sözen S, Emir S, Bali İ (October 1, 2015) Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri. International Journal of Basic and Clinical Medicine 2 1 8–13.
IEEE S. Sözen, S. Emir, and İ. Bali, “Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri”, International Journal of Basic and Clinical Medicine, vol. 2, no. 1, pp. 8–13, 2015.
ISNAD Sözen, Selim et al. “Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri”. International Journal of Basic and Clinical Medicine 2/1 (October 2015), 8-13.
JAMA Sözen S, Emir S, Bali İ. Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri. International Journal of Basic and Clinical Medicine. 2015;2:8–13.
MLA Sözen, Selim et al. “Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri”. International Journal of Basic and Clinical Medicine, vol. 2, no. 1, 2015, pp. 8-13.
Vancouver Sözen S, Emir S, Bali İ. Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri. International Journal of Basic and Clinical Medicine. 2015;2(1):8-13.
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