Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery.
BACKGROUND
Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. This study specifically examined the effect of previous intraabdominal surgery on the feasibility and safety of laparoscopic cholecystectomy.


METHODS
Data from 1,638 consecutive patients who underwent laparoscopic cholecystectomy were reviewed and analyzed for open conversion rates, operative times, intra- and postoperative complications, and hospital stay.


RESULTS
Of the 1,638 study patients 473 (28.9%) had undergone previous abdominal surgery: 58 upper and 415 lower abdominal operations. The 262 patients who had undergone only a previous appendectomy were excluded from further analysis. Adhesions were found in 70.7%, 58.8% and 2.1% of patients respectively, who had previous upper, lower or no previous abdominal surgery with adhesiolysis required, respectively, in 78%, 30% and 0% of these cases. There were no complications directly attributable to adhesiolysis. Patients with previous upper abdominal surgery had a longer operating time (66.4 +/- 34.2 min), a higher open conversion rate (19%), a higher incidence of postoperative wound infection (5.2%), and a longer postoperative stay (3.4 +/- 2.1 days) than those who had undergone previous lower abdominal surgery (50.8 +/- 24 min, 3.3%, 0.7%, and 2.6 +/- 1.4 days, respectively) and those without prior abdominal surgery (47.4 +/- 25.6 min, 5.4%, 1.2%, and 2.8 +/- 1.9 days, respectively).


CONCLUSIONS
Previous abdominal operations, even in the upper abdomen, are not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with an increased need for adhesiolysis, a higher open conversion rate, a prolonged operating time, an increased incidence of postoperative wound infection, and a longer postoperative stay.
Second Department of Surgery, Democritus University of Thrace, Medical School, 6 I. Kaviri Street, 68 100 Alexandroupolis, Greece. akarayan@usa.net
A J
AJ
Karayiannakis
A
A
Polychronidis
S
S
Perente
S
S
Botaitis
C
C
Simopoulos
D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D002764:Cholecystitis / Q000150:complications / Q000601:surgery; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D000075202:Contraindications; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007432:Intraoperative Period / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012449:Safety; D013530:Surgical Wound Infection / Q000453:epidemiology; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome