Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri
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Tarih
2014
Yazarlar
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Cilt Başlığı
Yayıncı
Namık Kemal Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç Hastanemiz genel cerrahi kliniğinde yapılan laparoskopik kolesistektomi girişimlerinin demografik özelliklerinin saptanması, açık ameliyata geçiş oranının belirlenmesi, açığa geçiş nedenlerinin ortaya konması hedeflenmiştir. Materyal ve Metod Hastanemizde Eylül 2008- Agustos 2013 yılları arasında yapılan 568 laparoskopik kolesistektomi girişiminin kayıtları incelendi. Yaş ve cinsiyetleri, açığa geçiş nedenleri, akut kolesistit ve kronik kolesistit olguları, yaş gruplarına göre açığa geçiş oranları belirlendi. Bulgular Olgularımızın 525’ i kadın (% 92,4),43’ü erkektir (% 7,6), kadın/erkek oranı 12,1 idi. Ortalama yaş 45,5 ± 12,7 (18- 82), ortalama ameliyat süresi 60,2 (17-200 ) dakika idi. Ameliyat endikasyonları; 525 hasta kolelitiyazis (% 92,4), 33 hasta akut kolesistit (% 4,4) ve 6 hasta safra kesesi polibi (% 1), 2 hasta akalkülöz kolesistit (% 0,35) nedeni ile opere olmuştu. Olgularımızın 20’sinde(% 3,5) açığa geçilmiş, 10 olguda (% 1,2) intraoperatif komplikasyonlar gelişmişti. Mortalite yoktur. Hastanede ortalama yatış süresi 1,6 gündür (8 saat-26 gün). Açığa geçiş nedenleri; Calot üçgeninde yapışıklık (3 hasta), akut kolesistit (33 hasta), koledok taşı (2 hasta), geçirilmiş ameliyata bağlı yapışıklıklar (1 hasta), diseksiyon güçlüğü (2 hasta), organ yaralanması (2 hasta), anatomik varyasyon (1 hasta), taş dökülmesi (1hasta) olarak belirlendi. Sonuç Laparakopik kolesistektomide açığa geçişi arttıran en önemli faktör akut kolesistit gibi görünmektedir. Erkek cinsiyet, ileri yaş ve akut kolesistit halinin açık ameliyata geçiş riskini arttıran faktörler olduğu saptandı. Buna rağmen ilk tercih edilecek girişim şekli laparakopik kolesistektomi olmalıdır.
Aim To determine the number of laparoscopic cholecystectomy procedures, reasons and risk factors for conversion to open cholecystectomy, which were performed in the General Surgery Department of our Hospital. Materials and Methods 568 laparoscopic cholecystectomy procedures performed between 2008-2013 were analyzed. Patients’ age and sex were noted. The causes of conversion to open cholecystectomy, the number of acute cholecystitis and chronic cholelithiasis cases, conversion rates according to the age groups were determined. Results The sex distribution of the cases was 525 (92.4%) and 43 (7.6%) male (F/M: 4.1). Median age was45.5 ± 12.7 years (range: 18-82), median operative time was 60.2 minutes (range: 17-200). Indications for surgery, were chronic cholelithiasis in 525 (92.4%), acute cholecystitis in 33 (4.4%), and gall bladder polyps in 6 (1%), a calculous cholecystitis in 2 patient (% 0.35) were operated. Overall, conversion to open laparotomy was necessary in 20 patients (3.5%) Ten patients (1.2%) required reoperation due to complications.There was no mortality. Median post operative hospital stay was1.6 days (8 hours-28 days). Causes of conversion were determined as fibrosis in Calot’striangle (n=3), acute cholecystitis (n=33), stone in choledocus (n=2), adhesions due to previous operations (n=1), difficulty in dissection (n=2), organ injury (n=2), anatomical variation (n=1), perforation of gall bladder and seeding of Stones into abdominal cavity (n=1). Conclusion Acute cholecystitis seems to be the main factorin creasing the ratio of conversion to open cholecystectomy. Risk factors of conversion to open cholecystectomy were determined as follows: male gender, being elderly and the diagnosis of acute cholecystitis before the operation. However, laparoscopic cholecystectomy should be the first choice for all cases with cholelithiasis
Aim To determine the number of laparoscopic cholecystectomy procedures, reasons and risk factors for conversion to open cholecystectomy, which were performed in the General Surgery Department of our Hospital. Materials and Methods 568 laparoscopic cholecystectomy procedures performed between 2008-2013 were analyzed. Patients’ age and sex were noted. The causes of conversion to open cholecystectomy, the number of acute cholecystitis and chronic cholelithiasis cases, conversion rates according to the age groups were determined. Results The sex distribution of the cases was 525 (92.4%) and 43 (7.6%) male (F/M: 4.1). Median age was45.5 ± 12.7 years (range: 18-82), median operative time was 60.2 minutes (range: 17-200). Indications for surgery, were chronic cholelithiasis in 525 (92.4%), acute cholecystitis in 33 (4.4%), and gall bladder polyps in 6 (1%), a calculous cholecystitis in 2 patient (% 0.35) were operated. Overall, conversion to open laparotomy was necessary in 20 patients (3.5%) Ten patients (1.2%) required reoperation due to complications.There was no mortality. Median post operative hospital stay was1.6 days (8 hours-28 days). Causes of conversion were determined as fibrosis in Calot’striangle (n=3), acute cholecystitis (n=33), stone in choledocus (n=2), adhesions due to previous operations (n=1), difficulty in dissection (n=2), organ injury (n=2), anatomical variation (n=1), perforation of gall bladder and seeding of Stones into abdominal cavity (n=1). Conclusion Acute cholecystitis seems to be the main factorin creasing the ratio of conversion to open cholecystectomy. Risk factors of conversion to open cholecystectomy were determined as follows: male gender, being elderly and the diagnosis of acute cholecystitis before the operation. However, laparoscopic cholecystectomy should be the first choice for all cases with cholelithiasis
Açıklama
Anahtar Kelimeler
Laparoskopik kolesistektomi, açık kolesistektomi, komplikasyon, Laparoscopic cholecystectomy, open cholecystectomy, complication
Kaynak
Namık Kemal Tıp Dergisi (International Journal of Basic and Clinical Medicine)
WoS Q Değeri
Scopus Q Değeri
Cilt
2
Sayı
1
