Laparoskopik kolesistektomide konversiyona neden olan faktörler

Yıl 2024, , 37 - 41, 31.03.2024

Recep Çağlar

https://doi.org/10.52880/sagakaderg.1287730

Öz

Giriş ve Amaç: Laparoskopik kolesistektomi, semptomatik safra kesesi hastalığının tedavisi için altın standart cerrahi prosedürdür. Konversiyon bir başarısızlık ve bir komplikasyon değildir. Sadece hasta güvenliğini sağlamak ve komplikasyonlardan kaçınmak için atılan bir adımdır. Çalışmamızda laparoskopik kolesistektomi yapılan hastalarda konversiyon sıklığı ve konversiyona neden olan intraoperatif ve preoperatif faktörleri araştırmaktır. Gereç ve Yöntem: Hastanemizde kolelitiazis-kolesistit belirtileri ve semptomları olan ve batın ultrasonografisi ile teşhis konulan 4433 hastaya yapılan laparoskopik kolesistektomi vakaları retrospektif olarak incelendi. Hastalar yaş, cinsiyet, hastanede yatış süresi, önceden endoskopik retrograd kolanjio pankreatikografi (ERCP) yapılan, diabetes mellitus (DM), kronik firotik kolesistit, safra kesesi polibi, acil-elektif cerrahi olarak gruplara ayrıldı. Hastalarda konversiyon oranı ve neden olan faktörler araştırıldı. İstatistiksel testler için IBM SPSS for Windows, version 17,0 (IBM statistics for Windows version 17,0 IBM Corparation, Armonk, New York, United States) programı kullanıldı. Bulgular: Çalışmamızda konversiyon oranı % 0,85 idi. Erkek cinsiyet, hastanede yatış süresi, önceden ERCP uygulanması ve acil cerrahi uygulaması (akut-hidropik kolesistit), kronik fibrotik kolesistit gibi durumlar konversiyon grubu lehine anlamlı oranda fark olduğu görüldü. DM’ un konversiyon üzerine anlamlı ilişkisi bulunmadı. Sonuç: Konversiyon bir komplikasyon olarak görülmemelidir. Konversiyon hastanede kalış süresini uzatması ve maliyeti arttırmasına rağmen, olası komplikasyonları önlemeye yardımcı olarak maliyetin daha da artmasını önler. Konversiyon nedenlerinin tahmin edilmesi, cerrahın intraoperatif karşılaşabileceği potansiyel zorluklar hakkında bir fikir edinmesine yardımcı olabilir.

Anahtar Kelimeler

Konversiyon, Kolesistit, Kolelitiazis, Laparoskopik Kolesistektomi, Risk Faktörleri

Destekleyen Kurum

yoktur

Factors causing conversion in laparoscopic cholecystectomy

Öz

Introduction and purpose: Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure in the treatment symptomatic gall bladder disease. Conversion is not a failure or complication. It is only a step taken to ensure patient safety and to avoid complications. The objective of our study was to investigate the rate and the causative preoperative and intraoperative factors of conversion and to help surgeons have an idea about potential intraoperative challenges. Materials and methods: Laparoscopic cholecystectomy procedures performed on 4433 patients with signs and symptoms of cholelithiasis-cholecystitis who were diagnosed with abdominal ultrasonography were retrospectively reviewed. The patients were grouped on the basis of age, gender, length of hospitalization, history of preoperative endoscopic retrograde cholangiopancreaticography (ERCP), diabetes mellitus (DM), chronic fibrotic cholecystitis, gall bladder polyps, and urgent-elective surgery. The rate and causative factors of conversion were investigated. Statistical analyses were carried out using IBM SPSS for Windows, version 17.0 (IBM statistics for Windows version 17, IBM Corparation, Armonk, New York, United States) software package. Result: In our study, the conversion rate was 0.85%. Male gender, advanced age, increased length of hospitalization, history of preoperative ERCP, urgent surgery (acute-hydropic cholecystitis), and chronic fibrotic cholecystitis were the significant risk factors for conversion. DM had no effect on conversion. Conclusion: Conversion should not be necessarily regarded as a complication in laparoscopic cholecystectomy. Identifying patients with significant risk factors for conversion can significantly minimize the complications of the laparoscopic procedure. This may assist in identifying high-risk patients and reviewing surgical strategy in this patient group.

Anahtar Kelimeler

Conversion, Cholecystitis, Cholelithiasis, Laparoscopic Cholecystectomy, Risk Factors

Kaynakça

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