Determinaton of eligibility for laparoscopic cholecystectomy of elective patients

Abstract

We defined possible complications and difficulty grade of surgery at frequent symptomatic cholelithiasis cases and laparoscopic cholesistectomy surgeries which is accepted exclusive cure technique with evaluating a number of preoperative parameters. Fifty patients who applied to Ataturk University Medical Faculty Department of General Surgery with cholelithiasis diagnosis and planned to undergo laparoscopic cholesistectomy were included in this study. These patient’s volume of gallbladder, the extreme dimensions, thickness of wall, count of gallstone and dimensions of the biggest stone, length of cystic canal, measured by magnetic resonance cholangiopancreatography; preoperative ages, genders and preoperative endoscopic retrograde cholangiopancreatography story were recorded.To detect difficulty of patients’ surgery, a grading system was established based on surgery time, count surgery port, difficulty of Callot dissection, difficulty of bad dissection, intraoperative injury of bile duct, intraoperative gallbladder perforation, applying drainage and passing to open procedure parameters. The statical relationship of preoperative data and surgery points were analysed. The difficulty of surgery was not statically related with age, gender, thickness of wall of gallbladder, count of gallstone and dimensions of the biggest stone, length of cystic canal, and preoperative endoscopic retrograde cholangiopancreatography story (p>0.05). A meaningful relationship was found between surgery difficulty and gallbladder volume over 30 cm³ or extreme dimension over 40 mm (p<0.05). In conclusion, it is discovered that surgery difficulty degree increases when gallbladder volume is over 30 cm³ or it’s extreme dimension is over 40 mm. We suggest that surgeans must be careful at laparoscopic surgeries on gallbladders which have high volume or extreme dimention to decrease possible complications. J. Exp. Clin. Med., 2013; 30:331-334

Keywords

• Elective surgery; laparoscopic cholecystectomy; gallbladder

References

1. Akat, A.Z., Doğanay, M., Koloğlu, M., Gözalan, U., Dağlar, G., Kama, N.A., 2002. Tek merkezde yapılan 1000 vakada laparoskopik kolesistektominin değerlendirilmesi. Türkiye Klinikleri J. Med. Sci. 22, 133-141.
2. Akın, M.L., Erenoğlu, C., Filiz, E., Batkın, A., 1998. Laparoskopik kolesistektomi sonrasında oluşan intraoperatif minör komplikasyonların tedavisi. End-Lap. ve Minimal İnvaziv Cerrahi Derg. 5, 91-95.
3. Alponat, A., Kum, C.K., Koh, B.C., Rajnakova, A., Goh, P.M.Y., 1997. Predictivefactorsforconversion of laparoscopiccholecystectomy. World J Surg. 21, 629-633.
4. Cuschieri, A., Dubois, N.F., Mouiel, J., 1991. The European experiences with laparoscopic cholecystectomy. Am J Surg. 161, 385-387.
5. Dodds, W.J., Gron, W.J., Darweesh, R.M.A., et al., 1985. Sonographic measurements of gallbladder volume. Am J Gastroenterol. 145, 100910
6. Filho, I.A., Sobrinho, A.A.H., Rego, A.C.M., Garcia, A.C.M.A., Fernandes, D.P., Cruz, T.M., 2006. Influence of laparoscopy and laparatomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model. Acta Cir Bras. 21, 74-79
7. Fried, G.M., Barkun, J.S., Sigman, H.H., Joseph, L., Clas, D., Garzon, J., Hinchey, E.J., Meakins, J.L., 1994. Factors determining conversion to laparotomy in patients under going laparoscopic cholecystectomy. Am J Surg. 167, 35-41.
8. Majeskı, J., 2007. Significance of preoperative ultrasound measurement of gallbladder wall thickness. Amerıcan Surgeon. 73, 926-929.

9. Jites, N., Burcos, T., Voiculescu, S., Cristian, D., Dragomir, S., Angelescu, N., 2002. The capacity of preoperative ultrasonography in predicting