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KMID : 1035920170200010022
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Journal of Minimally Invasive Surgery
2017 Volume.20 No. 1 p.22 ~ p.28
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Laparoscopic Cholecystectomy after Upper Abdominal Surgery : Is It Feasible Even after Gastrectomy?
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Lee Jung-Min
Jeong Jin-Cheol
Kim Doo-Jin
Kim Joo-Seop
Ryu Tae-Suk
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Abstract
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Purpose: Laparoscopic cholecystectomy (LC) is now a standard operation for benign gallbladder (GB) disease. However, previous upper abdominal surgery (UAS) has been regarded as a relative contraindication for LC. The purpose of this study was to examine the effects of history of upper abdominal surgery including gastrectomy on the operative and postoperative results of LC.
Methods: A total of 769 patients underwent LC between March 2008 and December 2015, and the surgical outcomes of 45 patients who had a history of UAS were retrospectively compared with those who did not. Twenty of 45 patients with a history of UAS received gastrectomy, and the remaining 25 received non-gastrectomy UAS. The degree of adhesion and clinical outcomes were further compared between these two groups.
Results: The patients with a history of UAS required placement of a greater number of trocars, longer operation time, longer duration of drainage insertion, and higher open conversion rate (4.4%) compared to patients with no history of UAS. However, there were no significant differences in postoperative hospital stay or complication rate between the two groups. In the UAS group, 93.3% of patients required adhesiolysis. There were no significant differences in clinical findings or perioperative outcomes between gastrectomy group and non-gastrectomy group.
Conclusion: A history of UAS including gastrectomy increases the technical difficulty of LC as well as open conversion rate. However, LC can be a feasible and safe approach when performed with adequate methods.
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KEYWORD
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Laparoscopic cholecystectomy, Gastrectomy, Adhesion, Conversion to open sugery
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