Karayiannakis A J, Polychronidis A, Perente S, Botaitis S, Simopoulos C
Second Department of Surgery, Democritus University of Thrace, Medical School, 6 I. Kaviri Street, 68 100 Alexandroupolis, Greece.
Surg Endosc. 2004 Jan;18(1):97-101. doi: 10.1007/s00464-003-9001-4. Epub 2003 Oct 23.
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.
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.
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).
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.
既往腹部手术被报道为腹腔镜胆囊切除术的相对禁忌证。本研究专门探讨了既往腹腔内手术对腹腔镜胆囊切除术可行性和安全性的影响。
回顾并分析了1638例连续接受腹腔镜胆囊切除术患者的数据，包括开腹转换率、手术时间、术中和术后并发症以及住院时间。
在1638例研究患者中，473例（28.9%）曾接受过腹部手术：58例上腹部手术和415例下腹部手术。仅接受过阑尾切除术的262例患者被排除在进一步分析之外。分别在70.7%、58.8%和2.1%的曾接受过上腹部、下腹部或未接受过腹部手术的患者中发现粘连，其中分别有78%、30%和0%的病例需要进行粘连松解。没有直接归因于粘连松解的并发症。与曾接受过下腹部手术的患者（分别为50.8±24分钟、3.3%、0.7%和2.6±1.4天）和未接受过腹部手术的患者（分别为47.4±25.6分钟、5.4%、1.2%和2.8±1.9天）相比，曾接受过上腹部手术的患者手术时间更长（66.4±34.2分钟）、开腹转换率更高（19%）、术后伤口感染发生率更高（5.2%）且术后住院时间更长（3.4±2.1天）。
既往腹部手术，即使是上腹部手术，也不是安全的腹腔镜胆囊切除术的禁忌证。然而，既往上腹部手术与粘连松解需求增加、开腹转换率更高、手术时间延长、术后伤口感染发生率增加以及术后住院时间延长有关。
