The impact of prior intra-abdominal surgery on laparoscopic cholecystectomy.
The presence of abdominal wall scarring and intra-abdominal adhesions following prior abdominal surgery has been proposed as a relative contraindication to the performance of laparoscopic cholecystectomy. The impact of prior abdominal surgery on the management of symptomatic gall bladder disease was retrospectively reviewed. Three groups were evaluated: open, laparoscopic, and laparoscopic converted to open cholecystectomy. Clinical factors analyzed included lengths of operative time, postoperative hospitalization stay, medical risk (ASA Classification), and postoperative complications. In addition, factors contributing to the conversion from a laparoscopic to open procedure were evaluated to determine the impact of prior surgery on conversion. The records of 504 consecutive patients undergoing open and laparoscopic cholecystectomy were reviewed. Individuals having additional intra-abdominal procedures were excluded. A total of 175 patients were identified who had prior abdominal surgery and underwent a cholecystectomy. In patients requiring cholecystectomy who have had prior abdominal surgery, the following observations can be made regarding laparoscopic cholecystectomy: 1) The operative time is less compared to open cholecystectomy. 2) The advantage of a shorter postoperative stay is realized. 3) The conversion rate (7/158) is low. Five of the seven conversions were due to the dense adhesion that prevented safe needle/trocar placement. 4) The complication rate is not increased. 5) The successful completion rate of laparoscopic cholecystectomy following prior intra-abdominal surgery (95.6%) is high.
Wongworawat
M D
MD
Department of Surgery, Loma Linda University Medical Center, CA 92350.
Aitken
D R
DR
Robles
A E
AE
Garberoglio
C
C
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002764:Cholecystitis / Q000453:epidemiology / Q000601:surgery*; D002908:Chronic Disease; D000075202:Contraindications; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008485:Medical Audit; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D000267:Tissue Adhesions; D016896:Treatment Outcome