Ghnnam Wagih, Malek Jawid, Shebl Emad, Elbeshry Turky, Ibrahim Ahmad
Department of General Surgery, Mansoura Faculty of Medicine, 1 Elbahr Street, Elgomhoria, Mansoura, Egypt.
Ann Saudi Med. 2010 Mar-Apr;30(2):145-8. doi: 10.4103/0256-4947.60521.
Problems during laparoscopic cholecystectomy include bile duct injury, conversion to open operation, and other postoperative complications. We retrospectively evaluated the causes for conversion and the rate of conversion from laparoscopic to open cholecystectomy and assessed the postoperative complications.
Of 340 patients who presented with symptomatic gall bladder disease over a 2-year period, 290 (85%) patients were evaluated on an elective basis and scheduled for surgery, while the remaining 50 (14.7%) patients were admitted emergently with a diagnosis of acute cholecystitis.
The mean age of the patients was 41.9 (12.6) years. Conversion to laparotomy occurred in 17 patients (5%). The incidence of complications was 3.2%. The most common complication was postoperative transient pyrexia, which was seen in four patients (1.2%) followed by postoperative wound infection in three patients (0.9%), postoperative fluid collection and bile duct injury in two patients each (0.6%).
Laparoscopic cholecystectomy remains the 'gold standard' by which all other treatment modalities are judged. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertise.
腹腔镜胆囊切除术过程中存在的问题包括胆管损伤、转为开腹手术以及其他术后并发症。我们回顾性评估了转为开腹手术的原因、腹腔镜胆囊切除术转为开腹手术的比例,并对术后并发症进行了评估。
在两年期间因有症状胆囊疾病就诊的340例患者中,290例(85%)患者接受择期评估并安排手术,其余50例(14.7%)患者因急性胆囊炎急诊入院。
患者的平均年龄为41.9(12.6)岁。17例(5%)患者转为开腹手术。并发症发生率为3.2%。最常见的并发症是术后短暂发热,4例患者(1.2%)出现,其次是术后伤口感染3例(0.9%),术后积液和胆管损伤各2例(0.6%)。
腹腔镜胆囊切除术仍是评判所有其他治疗方式的“金标准”。从腹腔镜胆囊切除术转为开腹手术应基于外科医生合理的临床判断,而非因个人专业技能不足。