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KMID : 0870419970010010097
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
1997 Volume.1 No. 1 p.97 ~ p.103
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Gasless Laparoscopic Cholecystectomy For Acute Cholecystitis
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Kim Eung-Kook
Lee Keun-Ho
Chung Jae-Hee
Lee Hun-Hyo
Kim Seung-Nam
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Abstract
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Background/Aims: Laparoscopic cholecystectomy is a safe and effective treatment modality for calculous cholecystitis. But there are some difficulties in the case of acute cholecystitis because occasionally the procedure is time-consuming and complicated. Special air bag lifter set and polyurethane membrane retractor were designed for gasless laparoscopic cholecystectomy. To evaluate the efficacy of gasless laparoscopic cholecystectomy using these instruments, 16 patients underwent this unique operation. The results were analyzed and compared with those of conventional laparoscopic cholecystectomy under pneumoperitoneum in patients with acute cholecystitis.
Methods: The clinical medical records of 16 patients, who underwent gasless laparoscopic cholecystectomy between January 1995 and July 1996, were studied. The operating time, frequency of parenteral analgesics needed, conversion rate, postoperative morbidity and length of postoperative hospital stay were analyzed. The results were compared with those of acute cholecystitis patients, treated with conventional laparoscopic cholecy stectomy under pneumoperitoneum.
Results: Operation fields obtained with air bag lifter set and polyurethane membrane retractor were excellent: visualization of supraduodenal bile duct and anatomical structures in Calot’s triangle was feasible. Operating time were
shorter(p=0.005) and analgesics needed were less frequent(p=0.004) in gasless laparoscopic cholecystectomy. Conversion rate was also lower in gasless laparoscopic cholecystectomy(0/16, 0%) than in conventional laparoscopic cholecystectomy(2/18, 11%). Lengths of postoperative hospital stay showed no significant difference statistically(p=0.064).
Conclusion: Laparoscopic cholecystectomy for acute cholecystitis performed by experienced surgeons is safe and effective. It has all the benefits of minimally invasive surgery. Gasless laparoscopic cholecystectomy is thought to be superior to conventional laparoscopic cholecystectomy because it permits surgeons to use conventional surgical techniques under better visual fields.
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KEYWORD
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Gasless laparoscopic cholecystectomy, Acute cholecystitis
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