Laparoskopik Kolesistektomiden Açık Kolesistektomiye Dönüşü Etkileyen Faktörler

Yıl 2017, Cilt: 6 Sayı: 3, 50 - 55, 30.09.2017

Turgut Anuk Şahin Kahramanca

Öz

Laparoskopik kolesistektomi (LK), safra kesesi hastalıklarında altın standart tedavi yöntemi olarak kullanılmaktadır. Ancak, bazı olgularda konversiyon kolesistektomi uygulanabilmektedir. Akut kolesistit, ileri yaş, koledokolithiaziste konversiyon riski artmaktadır. Çalışmamızda LK esnasında, konversiyon gelişmesine etki eden ve bunu öngörebilen faktörleri ortaya koymayı amaçladık. 

Kolelithiazis tanısı olan hastalarda yaş, cinsiyet, preoperatif bakılan lökosit (WBC), aspartate amino transferaz (AST), alanine amino transferaz (ALT), total ve direkt billirubin değerleri, safra kesesi duvar kalınlığı, intralüminar taş boyutu ve koledok çapı değerlendirildi. Hastalar konversiyon kolesistektomi ve laparoskopik tamamlananlar olarak 2 gruba ayrıldı ve gruplar arası karşılaştırma yapıldı.

Gruplar arasında cinsiyet farkılığı görülmezken (p:0.152), ileri yaş hastalardaki operasyonlarda konversiyon oranı yüksekti (p:0,039). Safra kesesi duvar kalınlığı ve koledok çapı artmış hastalarda konversiyon oranlarının arttığı tespit edildi (p<0,001 ve p:0,015). Başvuru anında bakılan ALT, total ve direkt bilirubin değerleri de Grup 1’de yüksekti (p:0,014, p<0,001 ve p<0,001). WBC, AST ve intraluminar taş boyutunun, konversiyonu öngörebilmede etkin olmadığı sonucu görüldü (p:0,177, p:0,210 ve p:0,180).    

Duvar kalınlığı ve koledok çapı artmış ileri yaştaki akut kolesistitli hastalarda preoperatif olarak konversiyon riskinin arttığı kanaatindeyiz.

Anahtar Kelimeler

Laparoskopik Kolesistektomi, Konversiyon, Kolesistit

Factors Affecting Conversion of Laparoscopic to Open Cholecystectomy

Öz

Laparoscopic cholecystectomy (LC) is used the gold standard treatment for gall bladder disease. However, some cases merit converting to open cholecystectomy. Reasons for conversion include acute cholecystitis and advanced age. In this study, we aimed to systematically assess factors that increase the likelihood of conversion.

We assessed age and gender as well as preoperatively noted leukocyte counts (WBC), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin, total and direct, levels; and gall bladder wall thickness of patients diagnosed with cholelithiasis. Patients were split into two groups: the open cholecystectomy group and the LC group. We then performed a comparative analysis between these two patient groups.     

We determined that these groups showed no significant difference regarding gender (p = 0,152). Moreover, the conversion rate was significantly higher in older patients (p = 0,039), and increased gall bladder wall thickness and common bile duct diameter also enhanced the conversion rate (p < 0,001 and p = 0,015). In addition, open cholecystectomy patients had higher ALT and total and direct bilirubin levels than LC patients (p = 0,014, p < 0,001 and p < 0,001, respectively). However, WBC, AST levels, and stone sizes were not significantly different between patient groups (p = 0,177, p = 0,210 and p = 0,180, respectively).

In summary, we found that increased wall thickness and common bile duct diameter led to acute cholecystitis in elderly patients and enhanced the risk of conversion.

Anahtar Kelimeler

Laparoscopic Cholecystectomy, Conversion, Cholecystitis

Kaynakça

• Chand, P., Singh, R., Singh, B., Singla, RL. and Yadav, M. Niger J Surg. Preoperative Ultrasonography as a Predictor of Difficult Laparoscopic Cholecystectomy that Requires Conversion to Open Procedure. 2015; 21(2): 102–105.
• Mok, K.W.J., Goh, Y.L., Howell, L.E. and Date, R.S. Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study. J Minim Access Surg. 2016; 12(1): 26–32.
• Lal, P., Agarwal, P.N., Malik, V.K., Chakravarti, A.L. Difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS 2002; 6: 59–63.
• Rothman, P.J., Burcharth, J., Pommergaard, G.C., Viereck , S., Rosenberg, J. Preoperative risk Factors for conversion of laparoscopic cholecystectomy to open surgery - A systematic review and meta-analysis of observational studies. Dig Surg. 2016; 33(5): 414-23.
• Beksac, K., Turhan, N., Karaagaoglu, E., Abbasoglu, O. Risk factors for conversion of laparoscopic cholecystectomy to open surgery: A new predictive statistical model. J Laparoendosc Adv Surg Tech A. 2016 Jul 6.
• Yang, T.F., Guo, L., Wang, Q. Evaluation of preoperative risk factor for converting laparoscopic to open cholecystectomy: A meta-analysis. Hepatogastroenterology. 2014; 61(132): 958-65.
• Ghnnam, W., Malek, J., Shebl, E., Elbeshry, T. and Ibrahim, A.. Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia. Ann Saudi Med. 2010; 30(2): 145–148.
• Kuldip, S., Ashish, O. Laparoscopic cholecystectomy: Is there a need to convert? J Minim Access Surg 2005; 1: 59–62. Takegami, K., Kawaguchi, Y., Nakayama, H., Kubota, Y., Nagawa, H. Preoperative grading system for predicting operative conditions in laparoscopic cholecystectomy. Surg Today 2004; 34: 331–6.
• Liu, C.L., Fan, S.T., Lai, E.C., Lo, C.M., Chu, K.M. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 1996; 131: 98 –101.
• Rajčok, M., Danihel, Ľ., Bak, V., Oravský, M., Schnorrer, M. Optimal timing of laparoscopic cholecytectomy in treatment of acute cholecystitis. Rozhl Chir. 2016; 95(3): 113-6.
• Goonawardena, J., Gunnarsson, R., de Costa, A. Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors. Am J Surg. 2015; 210(3): 492-500
• Sippey, M., Grzybowski, M., Manwaring, M.L., Kasten, K.R., Chapman, W.H., Pofahl, W.E., et al. Acute cholecystitis: risk factors for conversion to an open procedure. J Surg Res. 2015; 199(2): 357-61.
• Aydoğan, Ü., Doğaner, Y.Ç., Nerkiz, P. General approach to liver function tests in primary care. Turk Aile Hek Derg 2010; 14(3): 132-138
• Akcakaya, A., Okan, I., Bas, G., Sahin, G., Sahin, M. Does the difficulty of laparoscopic cholecystectomy differ between genders? Indian J Surg. 2015; 77: 452-6.
• Wiebke, E.A., Pruitt, A.L., Howard, T.J., Jacobson, L.E., Broadie, T.A., Goulet, R.J., et al. Conversion of laparoscopic to open cholecystectomy. Surg Endosc. 1996; 10: 742–5.
• Licciardello, A., Arena, M., Nicosia, A., Di Stefano, B., Calì, G., Arena, G., et al. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy. Eur Rev Med Pharmacol Sci 2014; 18: 60-68
• Ohta, M., Iwashita, Y., Yada, K., Ogawa, T., Kai, S., Ishio, T., et al. Operative timing of laparoscopic cholecystectomy for acute cholecystitis in a Japanese institute. JSLS 2012; 16(1): 65–70.
• Falor, A.E., de Virgilio, C., Stabile, B.E., Kaji, A.H., Caton, A., Kokubun, B.A., et al. Early laparoscopic cholecystectomy for mild gallstone pancreatitis: time for a paradigm shift. Arch Surg 2012; 147(11): 1031–1035.
• Shinke, G., Noda, T., Hatano, H., Shimizu, J., Hirota, M., Takata, A., et al. Feasibility and safety of urgent laparoscopic cholecystectomy for acute cholecystitis after 4 days from symptom onset. J Gastrointest Surg. 2015; 19(10): 1787-93.