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KMID : 0371319940460060968
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Journal of the Korean Surgical Society
1994 Volume.46 No. 6 p.968 ~ p.975
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Clinical Review of 1,000 Laparoscopic Cholecystectomy at the Asan Medical Center
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이승규
최건무/황원영/권태원/막광민/홍석준/한덕종/안세현/김병식
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Abstract
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One thousand consecutive patients underwent laparoscopic cholecystectomy from September 1990 to January 1993 ar our institution. A total of 435 had a complicated presentation with acute cholecystitis(82), common bile duct stone(61), or previous
abdominal surgery(321) of the 1,000 patients, 37(3.7%) were converted to open cholecystectomy, usually because of marked inflammation and unclear anatomy. There were no deaths and the total postoperative complication rate was 91 of 1,000(9.1%).
Major
complications(1.1%) included 3 bile duct injuries, postoperative bleedings, 5 residual common duct stones and 1 peritonitis by stones spillage. All bile duct injuries were detected and suspected in the operative room and repaired by Roux-en-Y
hepaticojejunostomy. Minor complications occurred in the remaing 80 patients(8.0%). Most common complication was urinary retention(6.1%). Intraoperatively, two-hand technique, electrosurgical dissection, selective cholangiography and selective
use
of
closed drainage wer used. When common bile duct stone were encounterd during the performance of laparocopic cholecystectomy, they wer primarily managed by simultaneons laparoscopic choledochotomy. These experiences suggested that immediate
detection of
operative injury was very important to prevent serious late complications, and wider operative indications can be applied safely and carefully by the trained general surgeons.
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KEYWORD
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